虚挂线联合置管引流术与切开挂线术治疗高位肛瘘的疗效对比

摘要

目的 对比虚挂线联合置管引流术与切开挂线术治疗高位肛瘘的疗效.方法 纳入2014年9月至2016年9月本院80例高位肛瘘患者作为研究对象,随机分为观察组及对照组,每组各40例.观察组行虚挂线联合置管引流术,对照组行常规切开挂线术.比较两组患者手术基本情况、手术疗效、手术前后肛门功能及并发症发生情况.结果 两组患者手术时间、住院时间及创面愈合时间差异均无统计学意义(均P＞ 0.05);观察组术中出血量和术后第2d疼痛评分显著优于对照组(均P＜0.05).两组手术总体疗效差异无统计学意义(P＞0.05),两组总有效率差异无统计学意义(P＞0.05).两组出院时和术后3月Wexner肛门功能评分和ARP均显著低于术前(均P＜0.05),观察组出院时和术后3月Wexner评分、ARP及AMCP均显著低于术前和对照组(均P＜0.05).观察组术后并发症总发生率显著低于对照组(P＜0.05),两组复发率差异无统计学意义(P＞0.05).结论 虚挂线联合置管引流术用于高位肛瘘患者可取得与常规切开挂线术相当的疗效,更有利于术后肛门功能的恢复及减少术后并发症的发生.%Objective To compare the effect of loose seton combined with drainage and routine incision and thread-drawing procedure for high anal fistula.Methods 80 patients with high anal fistula were recruited from our hospital from September 2014 to September 2016,and they were randomly assigned to the treatment group and the control group,with 40 cases in each group.The treatment group was treated with loose seton combined tube drainage,and the control group routine incision and thread-drawing.Indices related to operation,the effect of the operation,the anal function before and after the operation,and the occurrence of complications were compared between the two groups.Results There was no significant difference in operative duration,hospitalization duration and time to wound healing between the two groups (P ＞ 0.05).Amount of intraoperative bleeding and 2-day postoperative pain score in the treatment group were significantly better than those in the control group (all P ＜ 0.05).There was no significant difference in the total curative effect and total effective rate between the two groups (P ＞ 0.05).In both groups,the anal function score and ARP at discharge and 3 months after discharge were significantly lower than those before operation (all P ＜ 0.05).The scores of Wexner and ARP and AMCP at discharge and 3 months after discharge were significantly lower in treatment group than preoperative levels,were and lower than those in control group (P ＜ 0.05).The total incidence of postoperative complications in the treatment group was significantly lower than in the control group (P ＜ 0.05).There was no significant difference in the recurrence rate between the two groups (P＞ 0.05).Conclusion Loose seton combined with drainage can achieve the same effect as conventional incision and thread-drawing procedure inpatients with high anal fistula.It promotes postoperative anal function recovery and reduces postoperative complications.