2020 年第 5 期 第 15 卷

肛瘘精准微创术与传统肛瘘切开挂线引流术治疗肛瘘的近远期疗效比较

Comparison on short- and long-term curative effect of anal fistula precision minimally invasive surgery and traditional anal fistula incision-thread-drawing drainage on fistula incision

作者：杨铁军1;张婷2;吕文佳1

英文作者：Yang Tiejun1 Zhang Ting2 Lyu Wenjia1

单位：1中国人民解放军联勤保障部队第九○三医院综合外科，杭州310000；2杭州市萧山区第一人民医院产科311200

英文单位：1Department of General Surgery the 903rd Hospital of Joint Logistics Support Force of Chinese People′s Liberation Army Hangzhou 310000 China; 2Department of Obstetrics the First People′s Hospital of Xiaoshan District Hangzhou 311200 China

关键词：肛瘘；肛瘘精准微创术；传统肛瘘切开挂线引流术；近远期疗效

英文关键词：Analfistula;Analfistulaprecisionminimallyinvasivesurgery;Traditionalanalfistulaincision-thread-drawingdrainage;Short-andlong-termcurativeeffect

• 摘要：

• 目的 比较肛瘘治疗中应用肛瘘精准微创术与传统肛瘘切开挂线引流术的近远期疗效差异。方法 对于2018年2月至2019年2月中国人民解放军联勤保障部队第九○三医院收治的64例肛瘘患者相关资料予以回顾性分析。依据患者手术术式不同将接受肛瘘精准微创术与传统肛瘘切开挂线引流术患者分别纳入微创组（30例）与传统组（34例）。比较2组患者围术期相关指标，近期疗效，术后肛门排便功能情况，手术前后肛门括约肌功能，远期疗效。结果 微创组出血量、手术时间、术后疼痛评分、住院时间少于/短于/低于传统组，差异均有统计学意义（均P＜0.05）。微创组总有效率显著高于传统组［96.7%（29/30）比73.5%（25/34）］，差异有统计学意义（χ2=4.836，P=0.028）。微创组患者肛门失禁评分以及控便失禁严重度指数评分明显低于传统组患者（均P＜0.05）；手术后微创组肛管高压带长度、肛管静息压、肛管最大收缩压、直肠静息压等肛门括约肌功能指标明显高于传统组（均P＜0.05）。微创组复发率以及再发率与传统组比较差异均无统计学意义［3.3%（1/30）比17.6%（6/34）、0比5.9%（2/34）］（χ2=2.044，P=0.153；χ2=0.397，P=0.529）。结论肛瘘患者采用肛瘘精准微创术治疗远期疗效与传统肛瘘切开挂线引流术相当，但是其近期疗效较好，可显著缓解患者肛门功能障碍状态，对患者肛门括约肌功能影响小。

• Objective To compare differences in short- and long-term curative effect of anal fistula precision minimally invasive surgery and traditional anal fistula incision-thread-drawing drainage on fistula incision. Methods A retrospective analysis of 64 bladder patients admitted to the 903rd Hospital of Joint Logistics Surpport Force of Chinese People′s Liberation Army from February 2018 to February 2019 were performed.According to different surgical methods, patients undergoing anal fistula precision minimally invasive surgery or traditional anal fistula incision-thread-drawing drainage were included into minimally invasive group(30 cases) and traditional group(34 cases). The perioperative related indexes, short-term efficacy, anal defecation function after operation, anal sphincter function before and after operation, and long-term efficacy were compared between the two groups.Results The bleeding volume, operation time, postoperative pain score, and length of hospital stay in the minimally invasive group were shorter than those in the traditional group, and the differences were statistically significant (all P＜0.05). The total effective rate of minimally invasive group was significantly higher than that of traditional group［96.7%（29/30） vs 73.5%（25/34）］（χ2=4.836，P=0.028）. The scores of anal incontinence and defecation incontinence severity index in minimally invasive group were significantly lower than those in traditional group(all P＜0.05). After surgery, anal sphincters function indexes such as length of anal high pressure band, anal resting pressure, anal maximum systolic pressure and rectal resting pressure in minimally invasive group were significantly higher than those in traditional group(all P＜0.05). There were no significant differences recurrence rate and re-occurrence rate between minimally invasive group and traditional group［3.3%（1/30） vs 17.6%（6/34）, 0 vs 5.9%（2/34）］（χ2=2.044，P=0.153； χ2=0.397，P=0.529）. ConclusionThe long-term curative effect of anal fistula precision minimally invasive surgery is similar to that of traditional anal fistula incision-thread-drawing drainage on anal fistula patients. However, short-term curative effect of the former is better, which can significantly alleviate anal dysfunction status,with fewer effects on anal sphincter function.