中医挂线疗法治疗高位肛瘘临床研究

目的：探讨不同时间段橡皮筋脱落与手术前后肛门功能之间的关系,以及对各个时间段肛门功能的评估,得出合适的橡皮筋脱落时间段。方法：对62例高位肛瘘病例,行低位切开高位挂线术。以术后橡皮筋脱落时间为分组依据。试验1组橡皮筋脱落时间〈10 d;试验2组11 d≤橡皮筋脱落时间≤16 d;试验3组橡皮筋脱落时间〉16 d。观察手术前后的肛门直肠压力测定（静息压、收缩压、排便压改变率）、痊愈后wexner评分、随访0.5 a复发率。结果：痊愈时对比直肠肛管压力测定改变率试验1组与试验2组组间比较,差异有统计学意义（P〈0.05）,痊愈后wexner评分统计分析结果,试验1组与试验2组组间比较,P=0.00〈0.05,差异有统计学意义。结论：挂线治疗高位肛瘘中橡皮筋的脱落时间与术后肛门功能之间存在关联,当橡皮筋脱落时间在11 d到16 d之间时,痊愈后wexner评分以及直肠肛管压力测定改变率均明显低于橡皮筋脱落时间小于10 d时。即挂线橡皮筋在这个时间范围脱落,对肛门括约肌功能保护较试验1组理想。

Clinical Study on Ligation Therapy of Traditional Chinese Medicine For the Treatment of High Anal Fistula

Objective：To obtain the appropriate falling time quantum of rubber band through observing and studying the relationship of rubber band falling time in different time quantums and anal function before and after surgery,as well as assessing anal functions in different quantum.Methods：62 cases of patients with high anal fistula were given low-order cut and high-order seton surgery,and were divided into the first experiment group（t10 d）,the second experiment group（11 d≤t≤16 d） and the third experiment group（t16 d） according to the falling time（t） of rubber band after surgery.Anorectal manometry before and after surgery（included the change rates of resting pressure,systolic blood pressure and defecation pressure）,wexner grade after recovery,recurrence rate after half a year follow-up visit were observed.Results：Comparison of the change rate of anorectal manometry between the first experiment group and the second experiment group after recovery,showed that P0.05;comparison of the statistical analysis result of wexner grade after recovery between the first experiment group and the second experiment group showed that P=0.000.05 and the difference has statistical significance.Conclusion：There exists relevancy between falling time of rubber band and anal function after surgery in treating high anal fistula by ligation therapy.When the falling time of rubber band is between 11 d and 16 d,wexner grade after recovery and change rate of anorectal manometry are obviously lower than the rubber band falling time of less than 10d.Namely,ligation rubber band fells between 11 d and 16 d and it could protect ani sphincter better than the first experiment group.