配合对口引流的量化挂线法治疗高位肛瘘的随机对照临床研究

目的 探讨配合对口引流的量化挂线法治疗高位肛瘘的临床疗效.方法 144例高位肛瘘患者以密闭信封进行随机分层抽样,随机分配到观察组（采用配合对口引流的量化挂线法治疗,74例）及对照组（采用传统的切开挂线法治疗,70例）,比较两组疗效、疼痛视觉模拟评分（VAS）、肛门失禁Wexner评分及大便失禁生存质量指数（FIQLI）评分.结果 观察组痊愈40例,好转27例,无效7例,对照组痊愈25例,好转43例,无效2例,两组疗效比较差异有统计学意义（P＜0.01）.观察组切口愈合时间短于对照组,观察组术后第1,7天VAS低于对照组,差异均有统计学意义（P＜ 0.01或＜0.05）.两组术前肛门失禁Wexner评分及FIQLI评分比较差异无统计学意义（P＞0.05）,观察组术后3个月肛门失禁Wexner评分,FIQLI-生活方式、FIQLI-抑郁/自我感知、FIQLI-窘迫评分较同期对照组及术前均有所改善,差异有统计学意义（P＜0.05）,对照组术后3个月肛门失禁Wexner评分和FIQLI评分与术前比较差异无统计学意义（P＞0.05）.结论 配合对口引流的量化挂线法在高位肛瘘的治疗中有效,且可有助于改善患者生存质量.

Randomized controlled clinical study of modified seton therapy with counterparts drainage on high anal fistula

Objective To investigate the clinical effect of modified seton therapy with counterparts drainage on high anal fistula.Methods One hundred and forty-four patients with high anal fistula were randomly assigned to the observed group （modified seton therapy with counterparts drainage,74 cases） and the control group （the traditional high hanging line therapy,70 cases）.The clinical efficacy,visual analogue scale （VAS）,Wexner incontinence score,fecal incontinence quality of life index （FIQLI） score were compared.Results Observed group were cured with 40 cases,improved with 27 cases,ineffective with 7 cases,control group were cured with 25 cases,improved with 43 cases,ineffective with 2 cases,difference between two groups was statistically significant （P ＜ 0.01）.The healing time in observed group was significantly shorter than that in control group（P＜ 0.01）.The VAS after therapy 1,7 d in observed group was significantly lower than that in control group （P ＜ 0.05）.The Wexner incontinence score,FIQLI score before therapy was no significant difference between two groups （P ＞0.05）.The Wexner incontinence score,FIQLI-lifestyle score,FIQLI-depression/self-perception score,FIQLI-distress score after therapy 3 months in observed group was significantly higher than that before therapy and control group after therapy 3 months （P ＜ 0.05）,there was no significant difference Wexner incontinence score and FIQLI score before therapy compared with therapy 3 months in control group （P ＞ 0.05）.Conclusions Modified seton therapy with counterparts drainage may be a valid treatment for high anal fistula.The successful outcome is associated with significant improvement in quality of life.