肛瘘切除术联合肛门皮肤移植术治疗湿热下注型低位单纯性肛瘘疗效研究

发布时间：2018-04-26 02:01

本文选题：肛瘘 + 湿热下注　；参考：《广州中医药大学》2017年硕士论文

【摘要】：目的:肛瘘是临床常见病,手术是治疗肛瘘的主要方法,术后创面常愈合缓慢。通过观察比较肛瘘切除术联合肛门皮肤移植术与肛瘘切除术两种术式治疗湿热下注型低位单纯性肛瘘的临床疗效及手术安全性,为肛瘘切除术联合肛门皮肤移植术应用于肛痿的治疗提供一定的实践基础,为湿热下注型低位单纯性肛瘘提供一种安全有效的治疗方法。方法:选取湿热下注型低位单纯性肛瘘患者27例,用随机数字表法将患者随机分配到观察组和对照组,观察组行肛痿切除术联合肛门皮肤移植术,对照组行肛瘘切除术,分别观察两组手术时间、住院时间、愈合时间、治愈率、复发率等疗效指标和术后疼痛程度、出血程度及尿潴留发生率等安全指标,比较两组疗效及安全性。结果:1.手术时间比较:观察组患者手术时间为(62±18)min,对照组为(38±11)min,两组比较,差异有统计学意义(t=4.34,P0.05)。2.住院时间比较:观察组患者住院时间为(6.8±1.2)d,对照组住院时间为(5.6±2.6)d,两组住院时间相当,差异无统计学意义(p0.05)。3.愈合时间比较:观察组愈合时间为(14.4±3.2)d,对照组愈合时间为(38.7±13.6)d,观察组愈合时间显著短于对照组,差异有统计学意义(双侧p及单侧p均0.05)。4.术后当天疼痛程度及肌注止痛药用量比较:观察组患者术后当天疼痛程度以Ⅱ、Ⅳ度疼痛为主,Ⅱ度1例,Ⅳ度11例;对照组中,Ⅱ度4例,Ⅳ度11例。两组患者疼痛程度相比差异无统计学意义(χ2=1.485,p0.05)。术后肌注止痛药用量相比差异均无统计学意义(t=1.667,p0.05)。5.术后出血程度:观察组患者术后出血程度以Ⅰ、Ⅱ度出血为主,Ⅰ度3例,Ⅱ度9例;对照组中,Ⅰ度4例,Ⅱ度11例。两组患者出血程度相比差异无统计学意义(χ2=0.010,p0.05)。6.术后尿潴留比较:观察组患者术后有5例(42%)出现尿潴留,需导尿,7例(58%)无尿潴留发生;对照组患者中有6例(40%)尿潴留,9例(60%)无尿潴留发生。两组患者疼痛程度相比差异无统计学意义(P0.05)。7.肛门功能比较:观察组与对照组在肛门对气体、液体、固体等控制功能方面,差异无统计学意义(t=-0.891,p0.05)。8.治愈率比较:观察组全部患者创面均上皮化,反复肿痛流脓症状消失,治愈率100%,对照组有1例患者随访期间肛瘘症状反复,治愈率96.3%。差异无统计学意义(χ2=0.831,p0.05)。9.复发率比较:观察组患者随访期间未发现复发病例,对照组1例患者在术后6个月再出现流脓等症状,经换药等保守治疗后治愈,差异无统计学意义(χ2=0.831,p0.05)。结论:1.观察组患者手术时间长于对照组,主要因为观察组相比于对照组,需设计游离并将皮片缝合固定于创面,且肛门部手术野较小,将皮片与创缘缝合紧贴创面,属于较精细操作,术中耗时增加30min以内,所延长的手术时间并不明显增加手术风险,属于可接受的的差异。2.两组患者在治愈率、复发率、住院时间等指标比较上其差异无统计学意义,说明本术式并不显著延长患者住院时间,疗效相当于甚至优于经典的肛瘘切除术。3.本术式大大缩短了患者术后愈合时间,同时术后疼痛程度、出血程度、尿潴留发生情况以及肛门功能相比两组无显著差异,说明本术式具有患者术后愈合快,疗效可靠,手术安全性好等突出的特点及优势。
[Abstract]:Objective: anal fistula is a common clinical disease, operation is the main method for the treatment of anal fistula, and the wound healing is slow after operation. Through observation and comparison of the clinical efficacy and safety of two kinds of surgical treatment of humid lower simple anal fistula by anal fistula resection combined with anal skin grafting and anal fistula resection, the treatment of anal fistula combined with anal skin for anal fistula surgery. It provides a practical basis for the treatment of anal flaccid and provides a safe and effective treatment for the low position simple anal fistula with humid fever. Methods: 27 patients with low level anorectal fistula with low level of heat and heat were selected. The patients were randomly assigned to the observation group and the control group by the random digital table method. The observation group was treated with anal flaccid resection. Anus skin transplantation, control group underwent anal fistula resection, observe two groups of operation time, time of hospitalization, healing time, cure rate, recurrence rate, postoperative pain degree, bleeding degree and urinary retention, compare the curative effect and safety of the two groups. Results: the 1. operation time comparison: the operation time of the observation group Between (62 + 18) min and the control group (38 + 11) min, the difference was statistically significant (t=4.34, P0.05).2. hospital time comparison: the time of hospitalization of the observation group was (6.8 + 1.2) d, the time of hospitalization of the control group was (5.6 + 2.6) d, and the two groups were in the same time, the difference was not statistically significant (P0.05).3. healing time was (14.) healing time was (14.) (the time of union of observation group was (14.). 4 + 3.2) d, the healing time of the control group was (38.7 + 13.6) d, and the healing time of the observation group was significantly shorter than that of the control group. The difference was statistically significant (bilateral P and unilateral P 0.05). The pain degree and the dosage of painkillers were compared on the same day after.4.: the pain degree of the observation group was mainly II, IV degree pain, II degree 1, and 11 cases in the control group. The degree of pain in the two groups was not statistically significant (x 2=1.485, P0.05). There was no significant difference in the amount of pain relief drugs after operation (t=1.667, P0.05).5. after operation (t=1.667, P0.05). The degree of postoperative bleeding in the observation group was mainly I, II degree bleeding, I degree 3, and 9 cases; in the control group, 4 cases, I degree, I degree, degree I degree, I degree, I degree, I degree, in the control group. There were 11 cases of second degree. There was no significant difference in the degree of bleeding between the two groups (x 2=0.010, P0.05).6. postoperative urinary retention: 5 cases (42%) had urinary retention in the observation group and 7 cases (58%) had no urinary retention; 6 cases (40%) had urinary retention in the control group and 9 cases (60%) had no urinary retention. The difference of pain degree in the two group was different. No statistically significant (P0.05).7. anal function comparison: the observation group and the control group in the control function of the anus to the gas, liquid, solid and other control functions, the difference was not statistically significant (t=-0.891, P0.05).8. cure rate comparison: all the patients in the observation group were all epithelialization, repeated swelling and pain purulent symptoms disappeared, the cure rate was 100%, 1 cases in the control group were followed up. There was no statistically significant difference in the cure rate of 96.3%. (x 2=0.831, P0.05).9. recurrence rate: no recurrent cases were found in the observation group during the follow-up period, and 1 patients in the control group were reappeared after 6 months of operation, and the difference was not statistically significant (x 2=0.831, P0.05). Conclusion: 1. observation. The operation time of the group was longer than that of the control group, mainly because the observation group compared with the control group, it was necessary to design free and suture the skin slices to the wound, and the operation field of the anus was small, and the skin slices were sutured close to the wound, which was more fine operation, the time of operation increased less than 30min, and the extended operation time did not significantly increase the operation risk, There was no significant difference in the rate of cure, recurrence rate, and time of hospitalization in the two groups of patients with acceptable difference, which indicated that the operation did not significantly prolong the patient's time of hospitalization. The curative effect was equal to that of the classic anus fistulectomy, even better than the classical anus fistulectomy (.3.), which greatly shortened the postoperative healing time of the patients and the postoperative pain course. There were no significant differences between the two groups in degree, bleeding degree, urinary retention and anal function, which showed that the surgical method has the characteristics and advantages of quick healing, reliable curative effect and good operation safety.

【学位授予单位】：广州中医药大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R657.16

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