脱细胞异体真皮基质填塞术治疗高位肛瘘的临床对比研究

目的观察应用脱细胞异体真皮基质(AEM)治疗高位肛瘘的临床疗效,探讨高位肛瘘的微创治疗新方法。方法将2011年1月至2014年1月我院收治的100例高位肛瘘患者随机分成治疗组及对照组,每组各50例,治疗组采用AEM填塞术,对照组采用传统的肛瘘低位切开并高位挂线术,观察比较两组手术时间、术中出血量、术后疼痛评分(VAS评分)、术后疼痛持续时间、肛门失禁严重程度评分(Wexner评分)、创面愈合时间、手术一期成功率、治愈率、复发率及其他结果。结果治疗组一期手术成功46例,3例手术失败后再次行肛瘘低位切开并高位挂线术后痊愈,1例延迟愈合,一期治愈率94%(47/50)。对照组一期手术成功37例,13例术后合并不同程度术口感染,予术口换药、持续引流等治疗后,11例行二次高位瘘管切开并半缝合术后痊愈,2例延迟愈合,一期治愈率78%(39/50)。结论 AEM填塞术治疗高位肛瘘,具有创伤小、恢复快、疗程短、治愈率高和不损害肛门功能及外观的优点,可在临床上推广应用。

Clinical comparative study of allogenic acellular extracellular matrix in the treatment of high a-nal fistula

Objective To observe the clinical effect of acellular extracellular matrix to the treatment of high anal fistula,which was the minimally invasive treatment of high anal fistula treatment method.Methods From 201 1 to 2014 in our hospital,one hundred cases of high anal fistula were randomly divided into treatment group and control group,with 50 cases in each group.The treatment group were treated with allogenic acellular extracellular matrix operation,and the control group was used the traditional low incision and high anal fistula.The operation time,bleeding volume,postoperative pain score （VAS score）, postoperative pain duration,anal incontinence severity score （Wexner score）,wound healing time,operation a success rate,cure rate,recurrence rate and other results were observed and compared.Results The AEM tamponade were a total of 50 patients,with 46 cases were successfully carried out one stage operation.Failed procedure was performed in three patients,then the anal fistula low incision and high thread was performed.Delayed healing was found in 1 cases,and the cure rate was 94% （47/50）.Of the 50 patients performed the low incision and high hanging,37 cases were treated successfully with surgery.Thirteen cases with different degrees of wound infection,wound dressing,were cure in 11 cases after continuous drainage and high fistula incision and suture.Delayed healing were documented in 2 cases,with the cure rate was 78% （39/50）.Conclusion The AEM tamponade in treatment of high anal fistula was small trauma,quick recovery and short course of treatment.And the cure rate is high and does not damage the anal function and appearance,which can be widely applied in clinical practice.