基于肛门直肠高分辨检测方式对比两种肛瘘术式对肛门功能的影响

发布时间：2018-06-25 15:18

本文选题：高分辨肛门直肠测压 + 高位复杂性肛瘘　；参考：《福建中医药大学》2017年硕士论文

【摘要】：目的:低位切开高位挂线术式为治疗高位复杂性肛瘘的主流术式,疗效确切,但术后创面大,对肛门功能有不同程度的影响。我科通过改良传统术式,采用低位切开留皮桥高位挂线术式治疗高位复杂性肛瘘,既取得良好的疗效,又较好的保护了肛门功能,但缺乏相关客观数据的支持。高分辨肛门直肠测压,分辨率高、数据精确,可用于肛门精细功能的评估。通过其对两种不同术式术前、术后肛门功能的动力学相关指标的检测,评估手术对肛门功能的影响,验证低位切开留皮桥高位挂线术式的优越性。方法:选取符合纳入标准的患者40例,随机分成2组,治疗组(20例)采用低位切开留皮桥高位挂线的手术方式治疗,对照组(20例)采用低位切开高位挂线的手术方式治疗。观察两组肛肠动力学相关指标、愈合时间、疼痛、肛门功能(漏气、漏液、漏便情况)及复发率情况,并对指标进行统计学分析。结果:(1)治疗组和对照组经过治疗后总体疗效无显著性差异(P0.05)。(2)两组术后第1天疼痛评分无统计学差异,治疗组术后第7天、第14天、第21天疼痛低于对照组。(3)两组术后3个月、术后半年肛门功能(漏气、漏液、漏便情况)在统计学上有显著差异。(4)两组直肠肛管收缩反射与直肠肛管抑制反射在术后3个月、术后半年无统计学差异。(5)两组肛管静息压、肛管平均收缩压、肛管最大收缩压术后3个月较术前下降,治疗组术后半年较术前无统计学差异,对比两组在术后3个月、术后半年有统计学差异。(6)两组感觉测试初始感觉容量、最大耐受容量术后3个月较术前下降,治疗组术后半年较术前无统计学差异,对比两组在术后3个月、术后半年有统计学(7)两组肛管功能长度术后3个月较术前缩短,治疗组术后半年较术前无统计学差异,对比两组在术后3个月、术后半年有统计学差异。(8)治疗组术后愈合平均时间(47.80±6.092)天,对照组平均愈合时间(54.20±4.629)天,有统计学差异。结论:低切高挂术作为高位复杂性肛瘘的传统主流术式,疗效确切,但对肛门功能有不同程度的影响.低位切开留皮桥高位挂线术是我科在传统术式基础上的创新术式,在保护肛门括约肌、肛门功能,减轻术后疼痛,促进术后创面愈合等优越性,最大程度上减轻患者痛苦,提高患者术后生活质量。
[Abstract]:Objective: low incision and high end threading is the main method for treating high complex anal fistula. The curative effect is accurate, but the wound is large after operation, which has different influence on anal function. Our department improved the traditional operation and used low incision and skin bridge high position thread to treat high complex anal fistula, which not only achieved good curative effect, but also protected anal function well, but lacked the support of relevant objective data. High resolution anorectal manometry, high resolution, accurate data, can be used for the evaluation of anal fine function. The influence of operation on anus function was evaluated by detecting the dynamic indexes of anus function before and after two different operations, and the superiority of the high perpendicular ligature with low incision and skin bridge was verified. Methods: 40 patients who met the inclusion criteria were randomly divided into two groups. The treatment group (20 cases) was treated by the operation of low incision and left skin bridge, and the control group (20 cases) was treated by low incision and high thread. The related indexes of anorectal dynamics, healing time, pain, anal function (air leakage, leakage of fluid, leakage of stool) and recurrence rate were observed and analyzed statistically. Results: (1) there was no significant difference in the overall curative effect between the treatment group and the control group after treatment (P0.05). (2). There was no significant difference in pain score between the two groups on the first day after operation. The pain in the treatment group was lower than that in the control group on the 7th, 14th and 21st day after operation. (3) the pain in the two groups was lower than that in the control group at 3 months after operation. There were significant differences in anal function (air leakage, leakage of fluid, leakage of stool) between the two groups. (4) there was no statistical difference between the two groups in rectal anal reflex and rectoanal reflex at 3 months after operation and half a year after operation. (5) resting anal pressure was not significantly different between the two groups. The mean systolic pressure of anal canal and the maximum systolic pressure of anal canal decreased 3 months after operation, but there was no significant difference between the treatment group and the preoperative half year. (6) the initial sensory capacity and maximal tolerance volume of the two groups were decreased 3 months after operation, but there was no significant difference between the two groups in the half year after operation, and in the three months after operation, there was no statistical difference between the treatment group and the treatment group, and there was no significant difference between the two groups in 3 months after operation. The length of anal canal function in two groups was shorter than that before operation in 3 months after operation, but there was no significant difference in treatment group in half a year after operation, and there was no significant difference between the two groups in 3 months after operation. (8) the average healing time was (47.80 卤6.092) days in the treatment group and (54.20 卤4.629) days in the control group. Conclusion: low shear and high hanging operation is the traditional main operative method of high complex anal fistula, the curative effect is accurate, but it has different influence on anal function. Low incision and left skin bridge is an innovative operation based on the traditional operation, which can protect anal sphincter and anal function, relieve postoperative pain, promote wound healing, and alleviate the pain of patients to the greatest extent. To improve the quality of life after operation.
【学位授予单位】：福建中医药大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R657.16

【参考文献】