挂线疗法治疗高位肛瘘的临床疗效评价
发布时间：2019-02-18 14:20
【摘要】：目的:通过观察对比高位肛瘘患者低位切开高位挂线治疗与低位切开高位旷置术后的疼痛、愈合时间、肛门控便能力、肛门压力测定、术后复发率等数据,形成一套治愈率高、术后痛苦小、住院时间短,而且能最大限度维护肛门功能的疗法,从而达到使用规范挂线疗法治疗高位肛瘘的目的。材料与方法:采纳自2012年3月至2014年1月期间的200例高位肛瘘病例(均为沈阳市肛肠医院住院患者),随机分为两个观察组,分别为治疗组与对照组,两组对照观察,随访半年。作为观察研究的数据的有:术后的VAS疼痛评分(术后72、168小时疼痛评分)、术后疗效评价、术后7天创面分泌物情况、手术前后的肛门直肠压力测定(静息压、最大收缩压)、手术前后肛门功能评价、wexner评分、术后复发率等。结果:经随访观察,两组间疗效评价比较P值0.05,无统计学意义;治愈时间比较,两组间经统计学软件分析P0.05,不具有统计学意义,无明显差异;术后疼痛以VAS评分为标准,对比术后72小时及168小时疼痛评分经统计学软件分析两组均可见P0.05,差异无统计学意义;术后7天创面分泌物情况两组间对照经统计学软件分析P0.05,无统计学意义;两组间手术前后功能评价及Wexner评分对比结果经统计学软件分析P0.05,差异无统计学意义;术前术后对比肛门直肠压力测定P0.05,不具有统计学意义;跟踪对比两组间术后六个月复发率,经统计学软件分析,P0.05两组间差异明显,具有统计学意义。结论:1、通过对患者对照分析后发现,治疗组低位切开高位挂线术用于治疗高位肛瘘与对照组低位切开高位旷置的治疗方式相比在临床疗效、术后7天创面分泌物情况以及术后Wexner评分等方面并未优于对照组;2、术后疼痛VAS评分方面,治疗组低位切开高位挂线没有明显优于对照组低位切开高位旷置术;而在术后治愈时间的对比中,治疗组低位切开高位挂线术没有明显的优于对照组低位切开高位旷置术,在病程的缩短上没有体现出明显的优势。3、在术后六个月随访观察中发现,复发率方面两者的差异较明显,治疗组低位切开高位旷置明显的优于对照组低位切开高位旷置术。作为临床中较为常用的治疗高位肛瘘的术式,低位切开高位挂线用以橡皮筋起到慢性切割、异物刺激的作用,在对括约肌慢性切割的同时保证了组织愈合的同步性,避免了施治肛瘘处的括约肌出现突然大面积的损伤,能够保证肛直角的完整,避免或尽量减少肛管直肠环的损伤从而保证了对肛门扩约功能的保护。低位切开高位挂线术在继承了上述挂线疗法的优点的基础上,通过挂松线的方式避免了紧线对瘘管处括约肌的强烈刺激,明显减轻了挂线过程中对患者造成的疼痛。这也与现代外科学的微创理念不谋而合,在尽量减少组织损伤和减轻患者痛苦的前提下,收获同样的治疗预期。而在控制复发率方面,由于挂线方法与低位切开高位旷置术相对比对疾病治疗更加彻底,对形成假腔控制的更为理想,所以在临床中具有推广使用的价值。
[Abstract]:Objective: To establish a set of data such as pain, healing time, anal-control, anal pressure and postoperative recurrence rate after the low-position high-position hanging-line treatment and low-position high-position hanging-line treatment in the high-order anorectal cancer patients, and to form a set of data with high cure rate, small postoperative pain and short hospital stay. but also can furthest maintain the treatment of the anus function, so as to achieve the purpose of using the standard wire-hanging therapy for treating the high-level anorectal cancer. Materials and Methods: 200 high-order anorectal cases (all of which were in-hospital patients in the hospital of anorectal hospital in Shenyang) from March 2012 to January 2014 were randomly divided into two groups: the treatment group and the control group, the two groups of control group and the follow-up half year. The data of the study were: VAS pain score (72, 168 hours post-operative pain score), postoperative efficacy evaluation, 7-day postoperative wound discharge, anal rectal pressure measurement before and after operation (resting pressure, maximum systolic pressure), and post-operative anal function evaluation. Wexer score, post-operative recurrence rate, etc. Results: The results of follow-up observation showed that the difference between the two groups was 0. 05, no statistical significance, no significant difference between the two groups, and no significant difference between the two groups. The postoperative pain was the standard of VAS. There was no significant difference between the two groups after the 72-hour and 168-hour pain scores compared with that of the two groups (P0.05). The preoperative and postoperative functional evaluation of the two groups and the comparison of the Wexer score were compared with that of the Wexer score (P0.05). The difference between the two groups was significant, and the difference between the two groups was statistically significant. Conclusion: 1. After the analysis of the patient's control, it is found that the low-position high-position hanging-line operation in the treatment group is used for the treatment of the high-position anal canal and the low-position high-position and high-position and high-position and high-position ligation of the control group in the clinical curative effect, The postoperative wound discharge and the postoperative Wexner score were not superior to those in the control group. In the aspect of postoperative pain VAS score, the low-position high-position hanging line of the treatment group was not significantly superior to that of the control group, while in the comparison of the postoperative cure time, in that follow-up observation of the six-month follow-up, it was found that the two difference in the recurrence rate was more obvious. The lower open high position of the treatment group was superior to that of the control group, which was superior to that of the control group. As a more commonly used technique for treating the high-position anal sphincter, the low-position high-position hanging wire is used for treating the rubber band to play a role of chronic cutting and foreign body stimulation, and the synchronicity of the tissue healing is ensured while the sphincter is chronic cutting, avoids the sudden large-area injury of the sphincter at the anus and the anus, can ensure the integrity of the right angle of the anus, avoid or minimize the damage of the anorectal ring, and ensure the protection of the function of the anus expansion. On the basis of inheritance of the advantages of the above-mentioned line-hanging therapy, the low-position-cut high-level hanging-line operation avoids the strong stimulation of the tight wire to the sphincter of the tube-hanging tube through the way of hanging the loose wire, and obviously reduces the pain caused to the patient during the process of the hanging line. This is also the combination of the minimally invasive idea of modern foreign science, and the same treatment is expected to be obtained on the premise of minimizing tissue damage and alleviating the patient's suffering. and in the aspect of controlling the recurrence rate, because the relative ratio of the hanging wire method and the low-position high-position high-position setting technique is more thorough than the treatment of the disease, the ideal for forming the pseudo-cavity control is achieved, and therefore, the method has the value of promoting the use in the clinic.
【学位授予单位】：辽宁中医药大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R657.16
本文编号：2425925
[Abstract]:Objective: To establish a set of data such as pain, healing time, anal-control, anal pressure and postoperative recurrence rate after the low-position high-position hanging-line treatment and low-position high-position hanging-line treatment in the high-order anorectal cancer patients, and to form a set of data with high cure rate, small postoperative pain and short hospital stay. but also can furthest maintain the treatment of the anus function, so as to achieve the purpose of using the standard wire-hanging therapy for treating the high-level anorectal cancer. Materials and Methods: 200 high-order anorectal cases (all of which were in-hospital patients in the hospital of anorectal hospital in Shenyang) from March 2012 to January 2014 were randomly divided into two groups: the treatment group and the control group, the two groups of control group and the follow-up half year. The data of the study were: VAS pain score (72, 168 hours post-operative pain score), postoperative efficacy evaluation, 7-day postoperative wound discharge, anal rectal pressure measurement before and after operation (resting pressure, maximum systolic pressure), and post-operative anal function evaluation. Wexer score, post-operative recurrence rate, etc. Results: The results of follow-up observation showed that the difference between the two groups was 0. 05, no statistical significance, no significant difference between the two groups, and no significant difference between the two groups. The postoperative pain was the standard of VAS. There was no significant difference between the two groups after the 72-hour and 168-hour pain scores compared with that of the two groups (P0.05). The preoperative and postoperative functional evaluation of the two groups and the comparison of the Wexer score were compared with that of the Wexer score (P0.05). The difference between the two groups was significant, and the difference between the two groups was statistically significant. Conclusion: 1. After the analysis of the patient's control, it is found that the low-position high-position hanging-line operation in the treatment group is used for the treatment of the high-position anal canal and the low-position high-position and high-position and high-position and high-position ligation of the control group in the clinical curative effect, The postoperative wound discharge and the postoperative Wexner score were not superior to those in the control group. In the aspect of postoperative pain VAS score, the low-position high-position hanging line of the treatment group was not significantly superior to that of the control group, while in the comparison of the postoperative cure time, in that follow-up observation of the six-month follow-up, it was found that the two difference in the recurrence rate was more obvious. The lower open high position of the treatment group was superior to that of the control group, which was superior to that of the control group. As a more commonly used technique for treating the high-position anal sphincter, the low-position high-position hanging wire is used for treating the rubber band to play a role of chronic cutting and foreign body stimulation, and the synchronicity of the tissue healing is ensured while the sphincter is chronic cutting, avoids the sudden large-area injury of the sphincter at the anus and the anus, can ensure the integrity of the right angle of the anus, avoid or minimize the damage of the anorectal ring, and ensure the protection of the function of the anus expansion. On the basis of inheritance of the advantages of the above-mentioned line-hanging therapy, the low-position-cut high-level hanging-line operation avoids the strong stimulation of the tight wire to the sphincter of the tube-hanging tube through the way of hanging the loose wire, and obviously reduces the pain caused to the patient during the process of the hanging line. This is also the combination of the minimally invasive idea of modern foreign science, and the same treatment is expected to be obtained on the premise of minimizing tissue damage and alleviating the patient's suffering. and in the aspect of controlling the recurrence rate, because the relative ratio of the hanging wire method and the low-position high-position high-position setting technique is more thorough than the treatment of the disease, the ideal for forming the pseudo-cavity control is achieved, and therefore, the method has the value of promoting the use in the clinic.
【学位授予单位】：辽宁中医药大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R657.16
【参考文献】
相关期刊论文 前1条
1 苏克宁;手术治疗高位复杂性肛瘘30例体会[J];大肠肛门病外科杂志;1996年04期
，本文编号：2425925
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