二氧化碳激光治疗120例肛瘘的疗效观察

为减轻肛瘘术后疼痛、出血和感染 ,加速切口愈合 ,减轻患者的痛苦 ,避免复发 ,就二氧化碳激光治疗 12 0例肛瘘的临床资料报告如下。临床资料一、一般资料 :自 1996～ 2 0 0 2年共收治肛瘘 12 0例 ,其中男性 86例 ,女性 3 4例 ,年龄最大 72岁 ,最小 18岁 ,平均 3 6岁。病程最长 2 8年 ,最短 0 .5年 ,平均 8年。低位单纯性肛瘘 69例 ,低位复杂性肛瘘 2 2例 ;高位单纯性肛瘘 18例 ,高位复杂性肛瘘 11例。二、方法 :术前备皮、清洁灌肠 ,术中采用骶管麻醉。麻醉满意后 ,患者取左侧卧位 ,常规消毒手术区 ,铺无菌洞巾 ,1‰新洁尔灭消毒肛管及直肠…     

挂线疗法治疗肛瘘61例疗效观察

肛瘘指肛门周围的肉芽肿性管道由内口、瘘管、外口三部分组成,多由肛周脓肿引起,不能自愈,须经手术治疗。笔者自2004年5月至2007年8月对121例低位或高位单纯性肛瘘进行手术切除或挂线治疗分析,现报告如下。     

改良肛瘘切缝引流术治疗40例低位单纯性肛瘘疗效观察

目的观察改良肛瘘切缝引流术治疗低位单纯性肛瘘疗效。方法运用改良肛瘘切缝术治疗40例低位单纯性肛瘘,观察疗效及术后疼痛、出血发生率。结果本组治愈率100%,术后无1例感染、肛门关闭不全病例。随访半年无1例复发。结论改良肛瘘切缝引流术治疗低位单纯性肛瘘、术后出血少、痛苦小、疗效肯定。     

肛瘘栓微创植入封堵术治疗经括约肌肛瘘16例疗效观察

目的:探讨肛瘘栓微创植入封堵术治疗经括约肌肛瘘的临床效果.方法:将本院收治的32例经括约肌肛瘘患者随机分为治疗组和对照组,治疗组采用肛瘘栓微创植入封堵术治疗,对照组采用低位切开高位挂线术治疗.观察比较2组血清肌红蛋白水平、平均创面面积、疼痛、肛门坠胀和肛门失禁等情况.结果:术后1、4、7和14 d,治疗组血清肌红蛋白水...     

一期根治术治疗复杂性肛瘘150例疗效观察

为探讨一期根治术治疗复杂性肛瘘的临床疗效,回顾性分析150例复杂性肛瘘患者的临床资料。结果显示,150例一期治愈146例（97．3％）,假性愈合4例（2．7％）,经二次手术后均治愈,治愈率100％;平均住院时间（18．5±2．3）d;随访3个月至半年,无复发、无肛门失禁及肛门狭窄等并发症和后遗症。结果表明,复杂性肛瘘处理难度大,临床医师需掌握内口及瘘管的处理方法,采用一期根治术并积极做好术后处理,能有效提高治愈率。     

开窗对口引流术治疗马蹄形肛瘘90例疗效观察

目的探讨手术治疗马蹄形肛瘘的临床效果。方法采用主管道切开留桥挂线对口引流术治疗马蹄形肛瘘90例,观察临床疗效。结果一次手术治愈90例（98.9%）,二次手术治愈1例（1.1%）,随访1～5年,未见肛门失禁、肛门畸形,无复发。结论本术式治疗马蹄形肛瘘,安全有效,能保护肛门括约肌及局部正常组织,减少术后合并症及后遗症的发生。     

开放式瘘管切除术治疗肛瘘75例疗效观察

为观察开放式瘘管切除术治疗肛瘘的疗效,将肛瘘患者150例随机分为观察组和常规组,每组75例.观察组患者采用开放式瘘管切除术治疗,常规组患者采用传统肛瘘切除术治疗,观察2组患者的疗效,手术时间、创面愈合时间、住院时间、肛门功能评分、疼痛评分以及术后并发症和复发情况.结果显示,观察组患者治疗总有效率高于常规组(P<0.05...     

Hanley手术治疗低位复杂性肛瘘疗效观察

目的探究Hanley手术治疗低位复杂性肛瘘疗效。方法回顾性分析2009年3月至2011年6月我科收治的68例行Hanley手术治疗低位复杂性肛瘘患者的临床资料。结果一次性手术全部治愈,治愈率达100%;住院时间15～22d,平均20d,随访6～18个月,无复发,无肛门功能失禁等功能不良。结论 Hanley手术治疗低位复杂性肛瘘疗效确切,值得临床推广应用。     

手术治疗后位内口高位肛瘘126例疗效观察

为探讨对肛门组织特别是括约肌功能影响小、痛苦轻、复发率低的手术方法，对126例后位内口高位肛瘘患者，根据其瘘道走向采用切开挂线、切开加双挂线和切开挂线加改良留桥方法，一次治愈115例，无肛门失禁等并发症发生。     

悬浮与紧缩挂线术治疗复杂性肛瘘的疗效观察

为探讨治疗复杂性肛瘘较为有效的手术方式,采用悬浮与紧缩挂线术相结合治疗复杂性肛瘘34例（治疗组）,并与传统切开挂线术的28例（对照组）进行对比分析。结果显示,两组均获近期治愈,无复发,治疗组愈合时间为（19．7±0．3）d,瘢痕面积为（3．1±0．3）cm2;对照组愈合时间为（26．2±0．5）d,瘢痕面积为（7．6±0．4）cm。（P〈0．05）。结果表明,悬浮与紧缩挂线术治疗复杂性肛瘘的疗效优于传统切开挂线术。     

改良经括约肌间瘘管结扎术治疗括约肌间型及经括约肌型肛瘘的临床效果研究

目的：观察改良经括约肌瘘管结扎术（MLIFT）治疗括约肌间型肛瘘（ISAF）及经括约肌型肛瘘（TSAF）的疗效。方法：选取2016年1月1日—2020年12月31日上海市宝山区中西医结合医院肛肠科收治的190例TSAF和ISAF患者,随机分为治疗组（行MLIFT术）、对照组（行肛瘘切开挂线术）,术后常规清创、换药治疗;比较两组术后第1、3、7、14、21、30天的创面疼痛(VAS)、创面出血、肛门坠胀感、尿潴留及肛门控便能力(FISI)评分,比较两组治愈率及复发率情况,比较两组患者术前及术后1年的肛管静息压、肛管收缩压及肛管排便压的差异。结果：治疗组、对照组治愈率分别为87.37%、94.75%,差异无统计学意义(P>0.05);治疗组、对照组复发率分别为7.37%、2.11%,差异无统计学意义(P>0.05);术后第1、3、7天,治疗组VAS评分、创面出血和术后第14天创面出血评分均高于对照组(P <0.01);术后第1、7天,治疗组患者肛门坠胀评分和术后第1天尿潴留评分明显低于对照组(P <0.01);术后1年,治疗组患者肛管收缩压及肛管排便压明显高于对照组...     

The outcome of surgery for complex anal fistula

Objective The aim of this study was to examine the results of surgery for complex anal fistulas treated by a variety of techniques, in terms of fistula healing, recurrent anal sepsis and effect of surgery on anal continence. Patients and methods This study included 63 patients with complex fistulas treated between November 1995 and September 1999. A variety of techniques were employed, including short‐term loose seton drain (12), long‐term loose seton drain (11), cutting seton (17), and rectal advancement flap (19). Outcome was assessed at clinic review and continence was further assessed by detailed questionnaire sent to the patients sometime after surgery. Results Healing occurred in 9 (75%) patients treated with a short‐term, loose drainage seton; 16 (94%) patients treated with a cutting seton and 17 (89%) patients in the rectal advancement flap group. Incontinence reported at clinic review seemed to be more frequent in the advancement flap group. However, a detailed continence questionnaire revealed that 50% of patients reported episodes of incontinence to flatus or liquid after all techniques, which had not been detected at routine clinical review. Incontinence to solids was only reported by two of the patients who had been treated with a cutting seton. Conclusions Complex fistulas may be successfully treated by a variety of techniques. Disturbed anal continence following surgery is common and worse than clinic assessment would suggest.     

Anal fistula plug in the treatment of anal fistula: Local experience in Chinese patients

Background: Anal fistula plug was recently introduced as an alternative treatment for anal fistula. However, there is, so far, no published data on the use of the anal fistula plug both locally and in the Chinese population. Methods: From January 2007 to July 2008, consecutive Chinese patients with transphincteric or suprasphincteric anal fistula scheduled for elective surgery were enrolled. Anal fistula plug was used if examination under anaesthesia reviewed an internal opening. Baseline manometry pressure study was carried out for patients with recurrent fistulae. The operative technique was standardized. Measured outcomes included healing and recurrence rates, operating time, length of stay, and time for patients to return to work or normal activity. Results: Eleven patients underwent anal fistula plug placement, with a median follow up of 19 months. Five had completely healed fistulae, including three patients with recurrent fistulae. The success rate was 45 per cent. In the three patients with recurrent fistulae, no significant difference was demonstrated in the resting pressure between preoperative and postoperative values. There is an observable trend that proportionally more recurrent fistulae were healed by anal fistulae plug placement when compared to primary fistulae (100% vs 25%); the difference, however, did not reach statistical significance (P = 0.06, Fisher's exact test). At the conclusion of this study, no recurrence was noted in the five patients with confirmed healing. Conclusions: Our preliminary experience indicates anal fistula plug placement is safe and non-invasive. However, the efficacy appears lower than initially reported. Based on our data the routine use of an anal fistula plug cannot be recommended. In our opinion, anal fistula plug placement can be considered in patients with more complex, high fistulae and in those who have recurrent fistulae despite previous surgery. It provides a non-invasive alternative in these patients, in whom postoperative incontinence is a real concern.     

病理性肛裂组织切除治疗慢性肛裂疗效观察

目的 探讨病理性肛裂组织切除治疗慢性肛裂的疗效。方法 回顾分析2019年9月至2020年4月在我院接受病理性肛裂组织切除手术46例慢性肛裂患者的临床及随访资料,观察患者手术时间、术中出血量、术后并发症情况、术后疼痛评分、手术前后肛管静息压变化及临床疗效。结果 本组患者手术时间（35.91±12.35）min,术中出血量（7.33±3.48）mL。术后出现尿潴留4例（8.70%）,切口感染1例（2.17%）,未出现切口出血、肛门失禁等并发症。术后24 h疼痛评分（3.43±0.91）分,术后48 h疼痛评分（3.00±0.73分,术后72 h疼痛评分（2.22±0.76）分,术后1周疼痛评分（0.67±0.63）分。术前肛管静息压（19.86±2.24）kPa,术后3周肛管静息压（10.396±1.97）kPa,差异具有统计学意义（P=0.000）。创面愈合时间为（24.26±5.14）d。本组患者治愈42例（91.30%）,好转4例（8.70%）,有效率100%。中位随访时间8.2个月,无复发病例。结论 病理性肛裂组织切除术治疗慢性肛裂安全、有效。     

Incontinence rates after cutting seton treatment for anal fistula

Objective  To determine the incidence of anal incontinence after the use of cutting seton treatment for anal fistula.
Method  Literature searches were performed on PubMed, MEDLINE and Google^™ Scholar using the words 'cutting seton(s)', 'seton(s)' and 'anal fistula'. An analysis of the data in the collected references was performed.
Results  The average rate of incontinence following cutting seton use was 12%. The rate of incontinence increased as the location of the internal opening of the fistula moved more proximally. In the studies that described the types of incontinence, liquid stool was the most common followed closely by flatus incontinence. Incontinence associated with the treatment of fistulas defined as nonspecific cryptoglandular in nature was 18%.
Conclusion  The high incontinence rates that result from the use of cutting setons suggest that this commonly used therapy can damage the continence musculature. Other techniques that do not involve cutting the sphincter, when available, should be preferred, especially for higher fistulas.     

手术加抗痨治疗结核性肛瘘52例临床疗效分析

目的探讨手术加抗痨治疗结核性肛瘘的临床疗效。方法对采用2HRZE／4HR抗痨方案,手术切除瘘管及肛周结核病灶,术后每日用中药坐浴、熏洗伤1：3及利福平、异烟肼混合液换药治疗的52例结核性肛瘘患者临床资料进行回顾性分析。结果52例结核性肛瘘均一次手术治愈,疗程15-30d,随访1～3年,均无复发。结论结核性肛瘘应全程抗痨治疗与手术切除结核病灶相结合,术后伤口用中药坐浴、熏洗,抗痨药物换药,能有效促进伤口愈合,防止结核病灶复发。     

肛门功能评估在高位复杂性肛瘘治疗中的价值

目的探讨肛门功能评估在高位复杂性肛瘘治疗中的价值。方法对肛门功能评估的高位复杂性肛瘘患者72例,根据行肛瘘手术次数分别纳入0组、1组、2组、3组和4组。回顾性分析肛管直肠压力测定所得肛管静息压、肛管收缩压、肛管舒张压、括约肌功能长度、直肠肛门收缩反射、抑制反射和排便弛缓反射、直肠初始阈值及最大耐受量等指标,其中43例通过电话和门诊获得随访,平均随访时间(11.4±7.5)个月,比较术前和术后远期肛门失禁评分(Wexner法)。结果高位复杂性肛瘘患者肛管直肠压力测定的各项指标需要综合分析。四组患者肛管静息压、肛管收缩压、肛管舒张压比较差异均有统计学意义(P<0.001),直肠肛管抑制反射异常率差异有统计学意义(P<0.005),提示上述指标的降低及差异与手术次数有关。直肠肛管收缩反射和弛缓反射异常率及直肠感觉阈值差异无统计学意义(P>0.05)。43例获得随访的患者Wexner评分入院时0~6分,平均(2.4±0.2)分;随访时0~10分,平均(4.9±1.2)分(P<0.005)。结论应重视高位复杂性肛瘘患者的肛门功能评估,尤其是术前肛管直肠测压评估应得到推荐。     

主管虚挂引流治疗高位复杂性肛瘘的临床对比观察

目的探讨主管虚挂引流治疗高位复杂性肛瘘的价值。方法 60例高位复杂性肛瘘患者随机分为试验组和对照组,每组30例。试验组采用主管虚挂引流术,对照组采用传统切挂术。结果两组治愈率差异无统计学意义(P0.05),但两组间的术后疼痛程度、疼痛持续天数、创口愈合天数差异有统计学意义(P0.05),在肛门功能评价方面,两组手术后及组间肛门失禁评分(Wexner评分)及肛门动力学测试差异有统计学意义(P0.05)。结论主管虚挂引流术在治疗高位复杂性肛瘘痛苦小、疗程短,能有效地保护肛门括约肌功能,是较实用的手术术式。