LIFT术与肛瘘切开术治疗经括约肌肛瘘的近远期肛门功能变化观察

目的观察经括约肌间瘘管结扎术（LIFT）与肛瘘切开术治疗经括约肌肛瘘的近远期肛门功能变化。 方法选取深圳市南山区人民医院2015年9月至2017年2月收治的120例经括约肌肛瘘患者，随机分为观察组与对照组，每组各60例。对照组采取肛瘘切开术，观察组采取LIFT术。比较两组手术时间、创面愈合时间及术后第1 d、第3 d及第7 d的创面VAS疼痛评分，术后1个月的总治愈率、术后并发症总发生率及随访6个月的复发率，比较两组术前、术后1个月及术后6个月的肛门功能（应用盆底肌电图和肛门直肠压力测定进行评价）。 结果观察组创面愈合时间为（27.44±6.12）d，短于对照组（32.71±8.35）d（t=-3.943，P=0.000）；两组术后第1 d与第3 d的VAS疼痛评分无明显差异（P>0.05），观察组术后第7 d的VAS疼痛评分为（2.11±0.66）分，低于对照组（3.56±0.91）分（t=-9.991，P=0.000）。观察组与对照组愈合率分别为90.00%和93.33%，复发率分别为13.33%和10.00%，差异无统计学意义（P>0.05）。观察组术后并发症总发生率为3.33%，低于对照组13.33%（χ²=3.927，P=0.048）。观察组术后1个月与6个月的耻骨直肠肌、内括约肌、外括约肌运动单位电位（MUP）平均时限及肛管静息压与肛管最大收缩压与术前比较无统计学意义（P>0.05），对照组均下降（P<0.05）；观察组术后1个月与6个月的耻骨直肠肌、内括约肌、外括约肌MUP平均时限及肛管静息压与肛管最大收缩压均高于对照组。 结论LIFT术治疗经括约肌肛瘘可减轻手术对括约肌的损伤，从而减轻患者术后疼痛、促进创面愈合，减少术后并发症，使患者近远期肛门功能得到保护。

Observation on the changes of anal function in the treatment of transjottic anal fistula by LIFT technique and anal fistula incision

ObjectiveTo observe the effect of LIFT surgery and anal fistula incision on the metastatic anal fistula in the near-long anal function. MethodsA total of 120 patients with sphincter anal fistula treated in our hospital from September 2015 to February 2017 were randomly divided into observation group and control group, sixty cases in each group. The control group was treated with anal fistula incision, the observation group was treated with LIFT surgery. The operation time, wound healing time, the VAS pain score at 1 d, 3 d and 7 d after operation, the total cure rate, the total incidence of postoperative complications of 1 month after operation, the recurrence rate of followed up six months, the anal function (evaluated by pelvic floor electromyography and anal rectal pressure) of before operation and 1 month and 6 months after operation were compared between the two groups. ResultsThe wound healing time of the observation group was (27.44±6.12) d, which shorter than (32.71±8.35) d in the control group (t=-3.943, P=0.000). There were no significant difference in VAS pain scores between the two groups at 1 d and 3 d after operation (P>0.05). The VAS pain score of the observation group was (2.11±0.66) at the 7 th day after operation, which was lower than that of the control group (3.56±0.91) (t=-9.991, P=0.000). The healing rates of the observation group and the control group were 90.00% and 93.33%, and the recurrence rates were 13.33% and 10.00%, the difference were not significant (P>0.05). The total incidence of postoperative complications was 3.33% in the observation group, which was lower than 13.33% in control group (χ²=3.927, P=0.048). There was no significant difference between the mean time limit of MUP in the puborectal muscles, internal sphincter and external sphincter, anal canal resting pressure and anal canal maximum systolic blood pressure of 1 month and 6 months after operation were no statistically significant compared to preoperative in observation group (P>0.05), and were decreased in the control group (P<0.05). The mean time limit of MUP in the puborectal muscles, internal sphincter and external sphincter, anal canal resting pressure and anal canal maximum systolic blood pressure of 1 month and 6 months after operation in observation group were higher than those in control group. ConclusionThe LIFT treatment of the sphincter anal fistula can reduce the operation of the sphincter injury, thereby reducing the patient′s postoperative pain, promote wound healing, reduce postoperative complications, so that patients with near-term anal function was protected.