经括约肌间瘘管结扎术治疗前位肛瘘疗效观察

Evaluation of anorectal manometry in the treatment of anterior fistula-in-ano by ligation of the intersphincteric fistula tract

关键词:  经括约肌间瘘管结扎术  肛瘘切除术  肛瘘  肛门直肠测压

Key words:  ligation of the inersphincteric fistual tract (LIFT)  fistulectomy  fistula-in-ano  anorectal manometry

摘要:

目的　研究经括约肌间瘘管结扎术（LIFT手术）治疗前位单纯肛瘘的疗效及安全性，为临床治疗方案的选择提供依据。方法　选择2011年6月至2017年6月大连大学附属新华医院收治的168例前位单纯肛瘘患者，男136例，女32例，分为LIFT手术组和传统手术组，每组84例。LIFT手术组采用LIFT术式，传统手术组采用传统肛瘘切除术。观察两组的住院时间、平均愈合时间、治愈率、复发率、术后疼痛程度VAS评分、肛门失禁情况Wexner评分和肛管直肠测压的变化。结果　LIFT手术组治愈率95.24%（80/84）；传统手术组治愈率96.43%（81/84）。LIFT手术组在平均创面愈合时间、术后3天内VAS评分、术后1个月Wexner评分方面明显优于传统手术组，差异有统计学意义（P<0.05）。传统手术组患者术前与术后3个月的肛管直肠测压结果显示，术前与术后肛管最大收缩压差异有统计学意义（P<0.05）。传统手术组术后3个月肛管最大收缩压明显低于LIFT手术组术后3个月肛管最大收缩压，差异有统计学意义（P<0.05）。结论　LIFT手术创伤小、恢复快，无明显疼痛，无肛门失禁发生，是一种治疗肛瘘更加理想的方法。

Abstract:

Objective　 To investigate the clinical efficacy and safety of ligation of the intersphincteric fistula tract (LIFT) in the treatment of anterior fistula-in-ano. 　Methods　 A total of 168 patients (136 men and 32 women) with anterior fistula-in-ano were recruited from Xinhua hospital between June 2011 and June 2017．These patients were assigned to the experimental group (n=84) treated with LIFT and the control group (n=84) treated with fistulectomy．The follow-up period was 180 days．The following data were collected, including length of stay, mean healing time, healing rate, recurrence rate, Visual Analogue Scale (VAS), incontinence rate, and　changes of　anorectal manometry. 　Results　 Experimental group was superior to control group in mean healing time, Visual Analogue Scale (VAS) and incontinence Wexner score（P<0.05）. The anorectal pressure in control group was significantly different before and three months after surgery （P<0.05）. Experimental group is superior to control group in Anal maximum systolic pressure（MSP） three months later after surgery（P<0.05）.　Conclusion　 The total cure rates were 95.24%（80/84）in LIFT group and 96.43%（81/84）in fistulectomy group. LIFT has the advantages in less damage, faster surgical healing, less pain and less incontinence rate. Therefore, LIFT maybe a better treatment for anterior fistula-in-ano.