不同术式在复杂性肛瘘支管治疗中的对比分析-comparative analysis of different surgical methods in the treatment of complicated anal fistula.docxVIP

摘要目的：通过对比几种不同的手术方法在复杂性肛瘘支管中的疗效，从而找出 不同术式的优劣点及差异，为复杂性肛瘘的临床治疗提供参考。方法：选取 60 例符合观察标准的复杂性肛瘘的病人，按照随机原则根据入 院就治先后顺序随机分为治疗组 A 即开窗留桥浮线引流术、治疗组 B 即开窗旷置 术、治疗组 C 即对口拖线引流术，对照组即切开引流术。各治疗组术后均配合垫 棉加压法。术后对各组病人的疗效、一次手术治愈率、复发率、术后创面愈合时 间、术后一周内换药时的疼痛程度及肛门括约功能等方面进行对比观察。结果：四种术式的疗效、一次手术治愈率和复发率均无明显差异，P﹥0.05。 治疗组术后创面愈合时间明显短于对照组，P﹤0.01，各治疗组间无明显差异，P﹥0.05。术后 VAS 疼痛评估，治疗组 B 疼痛程度平均积分高于其余各组，P﹤0.05， 其余各组间无明显差异，P﹥0.05。出院随访均无严重的肛门失禁，但各治疗组肛 门括约功能平均积分均优于对照组，与对照组存在明显差异，P﹤0.05，各治疗组 间肛门功能评分经检验无明显差异，P﹥0.05。结论：在疗效、一次手术治愈率和复发率基本相同的前提下，要正确选择好 术式，开窗留桥浮线引流术和对口拖线引流术具有创面愈合时间较短、肛门功能 保护好、换药时疼痛较轻的优点，而开窗旷置术换药时疼痛较 重，不易被病人接 受。切开引流术，对于外口距离肛门近且位置低的复杂性肛瘘较适宜，有手术技 术要求相对低、手术成功率高的优势，但术后创面愈合时间较长、肛门功能保护 欠佳是其缺点。四种术式均是治愈复杂性肛瘘的有效方法，然以病人角度出发， 应提倡痛苦小、创伤小的术式，综合分析开窗留桥浮线引流术和对口拖线引流术 是目前治疗复杂性肛瘘较好的方法，值得临床推广。各治疗组术后配合垫棉加压 法明显加快了创面的愈合速度，且简单、实用，进一步体现了祖国医学的优势 。关键词：复杂性肛瘘开窗留桥术开窗旷置术拖线引流术垫棉法Clinical Comparison Study of Therapy for the branch tunnel of Complex Anal Fistula withDifferent OperationsZhang shengwei (Surgery of Traditional Chinese Medicine)Directed by Liu DianwenAbstractObjective：Use different operations cure the branch tunnel of Complex Anal fistula and compare the curative effect of the therapy in order to find out the merit and the flaw of these different operations .Methods：60 patients were divided randomly into therapy group and controlgroup. Therapy group was divide drandomly into 3 groups after exploration during operation. They were therapy group A (Fenestration and loose thread-drawingTherapy)； therapy group B (Fenestration and Put aside Therapy) and therapy group C(thread-dragging through fistula). Control group use the traditional incision and drainage. Compare the curative effect，rate of recurrence，healing by first intention， healing time，anal function and the degree of pain between the groups.Results： No in curative effect， the rate of recurrence and healing by first intention(P﹥0.05)，but therapy group could shorten the recovery time of the wound. (P ﹤ 0.01) ， there were no difference between therapy gr