改良肛瘘切开挂线术治疗高位肛瘘的临床观察

发布时间：2018-04-19 14:15

本文选题：改良切开挂线 + 保留括约肌　；参考：《河北医科大学》2017年硕士论文

【摘要】：目的:肛瘘是指由于病理原因在肛管或直肠形成的与肛门周围皮肤相通的一种异常管道。随着人们生活方式的改变,高位肛瘘在肛瘘中的发病率越来越高,而手术是治疗高位肛瘘最有效的方法。肛瘘切开挂线术是治疗高位肛瘘最常用的术式,虽然传统术式通过挂线疗法慢性切割肌肉,但是对肛门功能还是有一定的影响。现在如何在治愈疾病的情况下,最大限度的保留肛门括约肌的功能是我们研究的方向。通过研究改良肛瘘切开挂线术与传统切开挂线术治疗高位肛瘘的患者在术后治愈率(术后4周)、远期复发率(术后6个月)、术后疼痛(术后24小时)、住院时间及手术后肛门功能评分(术后4周)进行对照分析,来观察和评价应用改良肛瘘切开挂线术治疗高位肛瘘的临床疗效。方法:将80例符合纳入标准的高位肛瘘患者按随机方法分成治疗组和对照组,每组40例。经统计学检验,两组在年龄、性别、肛瘘类型方面,P0.05,差异无统计学意义,具有可比性(见Table1、Table2、Table3)。治疗组采用改良肛瘘切开挂线术,对照组采用传统肛瘘切开挂线术,观察分析两组的治疗效果,主要从术后治愈率(术后4周)、远期复发率(术后6个月)、术后疼痛、住院时间及手术后肛门功能评分(术后4周)进行观察评估比较。结果:1两组总体治愈率(术后4周)及远期复发率(术后6个月)的比较。(见Table4、Table5)治疗组术后4周达到痊愈标准40例,好转0例,无效0例,临床总治愈率为100%;对照组术后4周达到痊愈标准27例,好转11例,无效2例,临床总治愈率为95%;治疗组术后6个月回访,痊愈39人,1人复发,复发率为2.5%;对照组术后6个月回访,痊愈37人,3人复发,复发率为7.5%。两组在总体治愈率(术后4周)及远期复发率(术后6个月)经Fisher精确检验,P0.05,在治愈率与远期复发率无统计学差异。2两组术后疼痛情况比较(Table6)通过治疗组与对照组术后24小时疼痛评分对比,经秩和检验,P0.05,差异有统计学意义。术后治疗组在术后24小时疼痛程度明显低于对照组。3两组住院时间比较(Table7)两组术后住院时间比较,经t检验(两组数据符合正态分布和方差齐性),差异有统计学意义(P0.05),治疗组住院时间明显少于对照组。4两组在手术4周后肛门括约肌功能、肛门指诊情况评分的比较(Table8)通过两组在手术4周后肛门括约肌功能、肛门指诊情况评分的比较,经秩和检验,P0.05,差异有统计学意义;治疗组在术后4周肛门自制功能明显优于对照组。结论:1改良肛瘘切开挂线术与传统肛瘘切开挂线术均有满意的临床疗效。2改良肛瘘切开挂线术较传统肛瘘切开挂线术有效的减轻了术后疼痛。3改良肛瘘切开挂线术较传统肛瘘切开挂线术明显的缩短住院时间。4改良肛瘘切开挂线术较传统肛瘘切开挂线术能更好地保护肛门括约肌功能。
[Abstract]:Objective: anal fistula refers to an abnormal tube formed by the anal canal or rectum because of pathological causes. As the lifestyle changes, the incidence of high anal fistula in the anal fistula is getting higher and higher, and surgery is the most effective method for the treatment of high anal fistula. Anal fistula incision and hanging is the most common treatment for high anal fistula. Although the traditional surgical method has a certain influence on the function of the anus, it has a certain influence on the function of the anus. It is our research direction how to preserve the function of the anal sphincter to the maximum extent under the condition of curing the disease. The postoperative cure rate (4 weeks after the operation), the long-term recurrence rate (6 months after operation), postoperative pain (24 hours after operation), the time of hospitalization and the anal function score after operation (4 weeks after the operation) were analyzed to observe and evaluate the clinical efficacy of the modified anal fistula incision and thread operation in the treatment of high anal fistula. Methods: 80 cases were conformed to the high standard. The patients with anus fistula were randomly divided into treatment group and control group, with 40 cases in each group. The two groups had no statistical difference in age, sex and type of anal fistula by statistical test. The difference was not statistically significant (see Table1, Table2, Table3). The treatment group was treated with improved anal fistula cutting and hanging line operation, and the control group was divided into traditional anal fistula incision and hanging line, and the observation score was observed. Analysis of the curative effect of two groups, mainly from the postoperative cure rate (4 weeks after operation), the long-term recurrence rate (6 months after operation), postoperative pain, hospital time and postoperative anal function score (4 weeks after the operation) compared. Results: the total cure rate of 1 two groups (4 weeks after operation) and the long-term recurrence rate (6 months after operation). (see Table4, Table5) treatment group operation After 4 weeks, 40 cases were cured, 0 cases were improved, 0 cases were invalid, the total clinical cure rate was 100%, 27 cases were recovered in the control group 4 weeks after operation, 11 cases were improved, 2 cases were invalid, and the total clinical cure rate was 95%. The treatment group recovered 6 months after the operation, recovered 39, recurrent, recurrence rate. The rate was 7.5%. two in the total cure rate (4 weeks after operation) and the long-term recurrence rate (6 months after operation) by Fisher accurate test, P0.05, there was no statistical difference between the cure rate and the long-term recurrence rate (Table6) in group.2 two (Table6), compared with the 24 hour pain score of the treatment group and the control group, through the rank sum test, the difference was statistically significant. After 24 hours after operation, the pain degree of the treatment group was significantly lower than that of the control group.3 two groups (Table7), the time of hospitalization was compared between the two groups, and the difference was statistically significant (P0.05) by t test (P0.05), and the residence time of the treatment group was significantly less than that of the control group two groups after the operation 4 weeks after the operation. Compared with the anal sphincter function and anus diagnosis score after 4 weeks of operation, the comparison of the anal sphincter function and the anus diagnosis score of the two groups was statistically significant in the two groups. The treatment group was significantly better than the control group at 4 weeks after the operation. Conclusion: 1 improved anal fistula and traditional anal fistula in 1 anal fistula. .2 improved anal fistula incision and hanging line operation compared with traditional anal fistula incision and hanging line operation effectively alleviated postoperative pain.3 improved anal fistula incision and hanging thread operation compared with traditional anal fistula incision and hanging line operation, the improved anus fistula was significantly shorter in hospital time.4 improved anal fistula incision and hanging line surgery better than traditional anal fistula incision and hanging line operation can better protect the anus The function of the sphincter.

【学位授予单位】：河北医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R657.16

【参考文献】