瘘道潜行刨削联合LIFT术治疗经括约肌瘘的临床研究

发布时间：2018-02-09 05:13

本文关键词： 经括约肌瘘潜行刨削括约肌间瘘管结扎术(LIFT) 临床研究　出处：《南京中医药大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:观察瘘道潜行刨削联合LIFT术治疗经括约肌瘘的临床疗效,力争能够探求到一种既能避免肛门括约肌损伤又能保证提高疗效的肛瘘治疗革新术式,为微创外科手术方式治疗肛瘘的研究提供更多的临床经验和数据。方法:选取南京市中医院肛肠中心七病区自2015年09月～2017年02月期间收住、经王业皇教授团队手术的经括约肌瘘患者。选取病例共30例,依据知情自愿的原则分为两组行不同的手术治疗,两组都为15例,其中试验组患者通过瘘道潜行刨削联合LIFT术进行治疗,对照组患者通过经典的LIFT术进行治疗。对比两组患者术后的创面分泌物、术区疼痛水平以及感染等情况(观察时相点均为术后第1/4/7天),统计创面完全愈合的时间和近期疗效,并随访至少3个月观察远期疗效。结果:(1)所有患者随访至少3个月时试验组总有效率为93.33%,对照组总有效率为80.00%,试验组稍高于对照组,P值为0.435,差异无统计学意义(P0.05)。(2)两组的创面分泌物评分对比,术后第1天试验组明显优于对照组,P值为0.002,差异有显著统计学意义(P＜0.01);术后第4天试验组优于对照组,P值为0.021,差异有统计学意义(P0.05);术后第7天P值为0.559,差异无统计学意义(P0.05)。(3)两组的术区疼痛评分对比,术后第1天试验组明显优于对照组,P值为0.006,差异有显著统计学意义(P0.01);术后第4天P值为0.153、第7天P值为0.559,差异都无统计学意义(P0.05)。(4)两组的感染评分对比,术后第1天P值为0.252、第4天P值为0.559、第7天P值为0.153,三个时相点的差异都无统计学意义(P0.05)。(5)两组在创面愈合时间上对比,试验组(32.00±5.81)天、对照组(36.53±5.62)天,P值为0.038,差异有统计学意义(P0.05)。(6)术后随访至少3个月时两组患者的肛门功能主观症状均表现正常(100%),肛门形态均完整(100%)。结论:瘘道潜行刨削联合LIFT术治疗经括约肌瘘的方法是低痛苦低侵袭且安全有效的。本术式在确保治疗效果的同时,不仅能减少创面分泌物产生、减轻患者疼痛,而且能缩短创面愈合时间、保护肛门控便功能,值得进一步研究并用于临床。
[Abstract]:Objective: to observe the clinical effect of the treatment of sphincter fistulas with latent planing and LIFT operation, and to explore a new method of anal fistula treatment, which can not only avoid anal sphincter injury but also guarantee the improvement of curative effect. To provide more clinical experience and data for the study of the treatment of anal fistula by minimally invasive surgery methods: from September 2015 to February 2017, the seven areas of anal and intestinal center of Nanjing traditional Chinese Medicine Hospital were selected. A total of 30 patients with sphincter fistula underwent group operation by Professor Wang Ye-huang. According to the principle of informed and voluntary operation, 30 patients were divided into two groups, 15 patients in both groups. The patients in the experimental group were treated by the method of fistula planning combined with LIFT, while the patients in the control group were treated with classic LIFT. The wound secretion after operation was compared between the two groups. The pain level and infection in the operation area were observed at 1 / 4 / 7 days after operation. The time of complete wound healing and the short-term curative effect were counted. Results the total effective rate of the trial group was 93.33, the total effective rate of the control group was 80.000.The total effective rate of the trial group was slightly higher than that of the control group (P = 0.435). There was no significant difference between the two groups. The score of wound secretion was compared between the two groups. On the first day after operation, the test group was obviously superior to the control group in P value of 0.002, the difference was statistically significant (P < 0.01), on the 4th day after operation, the test group was superior to the control group in P value of 0.021, the difference was statistically significant (P 0.05), and on the 7th day after operation, the value of P was 0.559, there was no statistical difference. The score of pain in operation area was compared between the two groups. On the first day after operation, the P value of the trial group was significantly better than that of the control group (P = 0.006, P < 0.01), but on the 4th day, the P value was 0.153, the P value on the 7th day was 0.559, and there was no significant difference between the two groups. P value was 0.252 on the first day, 0.559 on the fourth day, and 0.153 on the 7th day. There was no significant difference among the three time points (P 0.05)) the wound healing time of the two groups was 32.00 卤5.81 days, and that of the experimental group was 32.00 卤5.81 days. In the control group, 36.53 卤5.62 days (P = 0.038), the difference was statistically significant (P 0.05). 6) at least 3 months after operation, the subjective symptoms of anal function of the two groups were normal and the anus shape was intact. Conclusion: the fistula canal subsurface planing combined with LIFT surgery is effective in the treatment of the patients. The method of transsphincter fistula is low pain, low invasion and safe and effective. It can not only reduce wound secretion and pain, but also shorten wound healing time and protect anal defecation function. It is worthy of further study and clinical application.
【学位授予单位】：南京中医药大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R657.16

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