瘘管外切+松挂线手术治疗复杂性肛瘘合并脓肿的评价

目的比较一期与分期外切松挂手术治疗复杂性肛瘘合并脓肿的临床疗效。 方法对2008年9月至2015年10月间88例复杂性肛瘘合并脓肿患者进行前瞻性随机研究,比较分析治疗组（53例,采用"一期瘘管外切+松挂"）和对照组（35例,采用"一期脓肿切开+二期肛瘘处理"）患者的临床特征、瘘型、术前及术后肛门功能状况（Wexner评分评估）、住院时间、治愈时间、复发率及并发症。 结果88例中最常见的肛瘘类型为肛管括约肌间瘘。治疗组与对照组的显愈率分别为92.5%和91.4%,差异无统计学意义（χ²=0.030,P=0.862）;治疗组术前及术后肛门失禁平均积分为1.8±1.3和1.9±1.3,对照组为1.7±1.5和2.0±1.2,两组差异无统计学意义（t=0.332、0.364,均P>0.05）;肛门失禁Wexner评分均在0~5分范围;尿潴留、轻微出血和伤口感染等并发症总发生率比较,组间差异无统计学意义（χ²=0.133,P=0.998）。术后随访0.5~4年,治疗组和对照组复发率比较差异无统计学意义（7.5% vs 8.6%,χ²=0.030,P=0.862）。治疗组的住院时间及创面痊愈时间分别为（5.9±0.3）d和（6.2±1.5）d,而对照组分别为（20.3±1.3）d和（25.2±1.2）d,差异有统计学意义（t=24.351、16.523,均P<0.01）,治疗组明显短于对照组。 结论一期"瘘管外切+松挂"手术与传统分期手术相比,具有痛苦小、疗程短、肛门功能保护好等优点,可成为治疗复杂性肛瘘合并脓肿的有效方法。

Evaluation of one-stage extra-dissection and loose seton operation in the treatment of complex anal fistula combined abscess

ObjectiveTo observe the clinical effect of one-stage extra-dissection and loose seton operation in the treatment of complex anal fistula combined abscess. MethodsFrom September 2008 to October 2015, eighty-eight cases of complex anal fistula were randomly divided into two groups, treatment group of 53 cases with one-stage extra-dissection and loose seton operation, control group of 35 cases with the first stage abscess dissection and the second stage extra-dissection and loose seton operation. The data between two groups including types of fistula, preoperative and postoperative anal functional status (Wexner score assessment), hospitalization time, cure time, recurrence rate and complications were compared. ResultsThe most common type of fistula was the anal intersphincteric fistula. The apparent healing rate of treatment group and control group was 92.5% and 91.4%, respectively, with no significant difference between the two groups (χ²=0.030, P=0.862). Preoperative and postoperative incontinence average credit of two groups were 1.8±1.3 and 1.9±1.3, 1.7±1.5 and 2.0±1.2 (t=0.332, 0.364, both P>0.05). Wexner incontinence scores were in the range of 0-5. There was no significant difference in complication rates (χ²=0.133, P=0.998). For a 0.5-4 years follow up, the two groups showed no difference in recurrence rate (7.5% vs 8.6%, χ²=0.030, P=0.862). The hospital stay and wound healing time of treatment group was (5.9±0.3) d and (6.2±1.5) d, while the control group was (20.3±1.3) d and (25.2±1.2) d, with a significant difference (t=24.351, 16.523, both P<0.01). ConclusionCompared with traditional stages, the one-stage extra-dissection and loose seton operation has advantages of less pain, shorter course, better protection of anal function for treating complex anal fistula combined abscess.