两种手术方式治疗高位肛瘘疗效的比较

目的探讨治疗高位肛瘘较为可靠有效的手术方式。方法对2002年1月至2004年1月收治的117例高位肛瘘患者分别用肛门外瘘管切除缝合加肛管内主管挂线法(切除组,62例)和肛门外瘘管旷置加肛管内主管挂线法(旷置组,55例)治疗;对两组患者的治愈时间、复发情况进行对照分析。结果切除组高位单纯肛瘘37例,高位复杂肛瘘25例;旷置组高位单纯肛瘘39例,高位复杂肛瘘16例。切除组患者的治愈时间为15-20(17±2)d,随访半年以上无复发病例。旷置组患者的治愈时间25-55(35±8)d,6例(10.9%)复发脓肿性肛瘘,其中1例(2.6%)术前诊断为高位单纯性肛瘘,5例(31.3%)为高位复杂性肛瘘。对于治疗高位复杂性肛瘘的疗效,两种方法比较,χ2=6.23,P=0.013;两组总体疗效比较,χ2=5.06,P=0.024;差异均具有统计学意义。结论肛门外瘘管切除缝合加肛管内主管挂线法用于高位复杂性肛瘘的治疗可获得较好的效果。

Comparison of two kinds of operations for high anal fistula

OBJECTIVE: To investigate the more reliable and effective operations for high anal fistula. METHODS: From Jan. 2002 to Oct. 2004, 117 cases suffering from high anal fistula were divided into two groups, and received tying therapy on main fistula with external anal fistulae excision (62 cases) or tying therapy on main fistula with external anal fistulae laid aside (55 cases). The curing time and recurrence were compared between the two groups. RESULTS: There were no significant differences in basic clinical data between the two groups. There were 37 cases of high simple fistula, and 25 cases of complicated fistulae in resection group, while 39 cases of simple fistula and 16 cases of complicated fiatulae in laying aside group. The curing time was 15-20 (17+/-2) days and no recurrence occurred after follow-up for half a year in resection group. The curing time was 25-55 (35+/-8) days and recurrence occurred in 6 cases (10.9%) in laying aside group including one case of high simple anal fistula and five cases of high complicated anal fistulae. There was statistical significance in treatment efficacy for high complicated anal fistulae (chi2=6.23, P=0.013), and the overall efficacy (chi2=5.06, P=0.024) between the two groups. CONCLUSION: Tying therapy on main fistula with external anal fistulae excision is a more effective treatment for high complicated anal fistulae.