内口切闭术与直肠粘膜瓣推移术对封闭内口效果的临床研究

发布时间：2018-10-20 10:21

【摘要】：目的:观察内口切闭术治疗肛瘘时对内口封闭的临床疗效。方法:病人总数30人,是2014年9月份-2017年3月份,在南京市中医院手术治疗肛瘘的病人,分组按自愿原则,共两组,试验组(n=15)采用内口切闭术,对照组(n=15)采用直肠黏膜瓣推移术。比较两组术后内口封闭情况、封闭内口手术时间、术后疼痛度、异物感等指标;观察试验组术中吻合钉吻合度及术后钛钉残留(肉眼可见)情况。结果根据评分记录,经统计学处理,分析评估其封闭内口的疗效、手术安全性等。结果:(1)通过统计学分析,两组的一般资料(包括性别和年龄)P值大于0.05,说明试验组与对照组具有可比性。(2)观察术后第3天、7天、14天,两组内口封闭情况及内口感染差异均无统计学意义(P0.05),说明术后3天、7天、14天,试验组和对照组内口闭合情况无明显差异。试验组封闭内口的手术时间范围5-9分钟,对照组封闭内口的手术时间范围5-12分钟,两组封闭内口的手术时间比较,差异无统计学意义(P0.05)。术后3天、7天、30天两组的疼痛评分比较,患者异物感评分比较,差异无统计学意义(P0.05)。由此可见内口切闭术与直肠黏膜瓣推移术相比较,内口封闭的效果相似,且术后造成的疼痛度与异物感上也无明显差异。(3)试验组在手术中切闭后,切闭后形成的吻合处钉子全部成型,其中只有有1例切闭处有活动性出血,可能与吻合边缘未能将切除的内口全部吻合,边缘出血有关。试验组手术后7天、30天,发现5例患者在术后7天内肉眼观察未发现钛钉,30天后15例患者吻合处钛钉在肉眼观察下均未发现,指诊无明显钛钉残留感。说明内口切闭术安全并且不会有明显的钛钉残留的问题。结论:内口切闭术在封闭内口方面与直肠黏膜推移术疗效相似,在疼痛、异物感,封闭内口手术时间部分有一定长处,操作安全。由此可见内口切闭术作为新术式微创安全疗效明确,值得进一步研究推广。
[Abstract]:Objective: to observe the clinical effect of internal mouth closure in the treatment of anal fistula. Methods: from September 2014 to March 2017, 30 patients were treated with anal fistula in Nanjing traditional Chinese Medicine Hospital. The patients were divided into two groups according to voluntary principle. The control group (nong15) was treated with rectal mucosal flap. The intraoperative closure time, postoperative pain, and foreign body sensation were compared between the two groups, and the anastomosis degree of intraoperative anastomosis and the residual titanium nail (visible to naked eyes) were observed in the experimental group. Results according to the score record, the curative effect and the safety of the operation were evaluated by statistical analysis. Results: (1) by statistical analysis, the general data (including gender and age) of the two groups were more than 0.05, indicating that the experimental group was comparable with the control group. (2) the 3rd, 7th and 14th days after operation were observed. There was no significant difference in internal mouth closure and infection between the two groups (P0.05), which indicated that there was no significant difference between the experimental group and the control group in the closure of the internal mouth 3 days, 7 days and 14 days after operation. The operation time range of the treatment group was 5-9 minutes, and that of the control group was 5-12 minutes. There was no significant difference between the two groups (P0.05). There was no significant difference in pain score and foreign body sensation score between the two groups on the 3rd, 7th and 30th day after operation (P0.05). It can be seen that the effect of internal closure is similar to that of rectal mucosal flap, and there is no significant difference in the degree of pain and foreign body sensation after operation. (3) after operation, there is no significant difference between the experimental group and the control group. All the nails formed after closure were formed, among which only one case had active bleeding, which may be related to the failure of the anastomotic margin to completely anastomose the excision of the inner orifice, and to the bleeding in the margin. In the test group, no titanium nail was found in 5 patients within 7 days after operation, and no titanium nail was found in the anastomosis of 15 patients after 30 days. This indicates that internal closure is safe and there is no significant residual titanium nail problem. Conclusion: the curative effect of internal incision closure is similar to that of rectal mucosal process, and it has some advantages in pain, foreign body sensation and the time of closing internal mouth, and it is safe to operate. This shows that internal incision closure as a new operation minimally invasive safety effect is clear, worthy of further study and promotion.
【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】：R657.1

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