隧道式拖线加内口切挂术治疗马蹄型肛瘘的效果

摘要

Objective To explore the efficacy of tunnel thread dragging and internal opening incision in the treatment of horseshoe anal fistula,and to summarize the clinical experience and application value.Methods Based on digital table extraction method,104 patients with horseshoe anal fistula who had been hospitalized during the period of September 2009 to September 2011 were randomly divided into study group and control group,52 for each group.The study group received tunnel thread dragging and internal opening incision,while the control group received conventional fistulectomy therapy.The efficacy,average healing time,and healing time of branch fistula were compared between the two groups.Results In the study group,52 patients were cured after the prirnary procedure,with a cure rate of 100％;no complications occurred;and no recurrence developed in a 6-month follow-up.While in the control group,42 patients were cured,with a cure rate of 80.8％;10 patients developed false healing due to improper dressing changes and were cured after receiving secondary procedure,with a repeat procedure rate of 19.2％;18 patients developed postoperative complications,with a rate of 34.6％;and 2 patients developed recurrence in a 6-month,with a rate of 3.8％.The cure rate for primary procedure,rate of secondary procedure,and rate of postoperative complications differed significantly between the two groups(P＜0.05).Average healing time and healing time of branch fistula also differed significantly(P＜0.05).Conclusions Tunnel thread dragging and internal opening incision for horseshoe anal fistula is efficacious and is obviously superior to traditional fistulectomy.It can significantly shorten the course of treatment,accelerate healing of branch fistula,reduce complications,lower the rate of secondary procedure,and improve clinical efficacy and safety and thus has important value in clinical application.%目的 探讨隧道式拖线加内口切挂术治疗马蹄型肛瘘的效果,总结其临床治疗经验及应用价值.方法 选取我院2009年9月至2011年9月收治的104例马蹄型肛瘘患者,采用数字表抽取法将其随机分为观察组与对照组,各52例.观察组使用隧道式拖线加内口切挂术治疗,对照组使用传统的瘘管切除法治疗,观察对比两组治疗效果、平均治愈时间、支管愈合时间.结果 观察组一次性手术治愈52例,治愈率100.0％,均未出现术后并发症;随访半年,无1例复发.对照组一次性手术治愈42例,治愈率为80.8％;由于换药不当导致创口发生假性愈合的有10例,后经二次手术治愈,二次手术率为19.2％;18例出现术后并发症,并发症发生率为34.6％;随访半年,复发2例,复发率为3.8％.两组患者的一次性手术治愈率、二次手术率、术后并发症发生率比较差异有统计学意义(P＜0.05).两组平均治愈时间、支管愈合时间对比差异具有统计学意义(P＜0.05).结论 隧道式拖线加内口切挂术治疗马蹄型肛瘘效果显著,明显优于传统的瘘管切除法,能够显著缩短疗程,加快支管愈合,减少并发症发生,降低二次手术率,临床有效性及安全性明显提高,具有重要的临床应用价值.