摘要: |
目的 探讨在中低位直肠阴道瘘手术治疗中应用藏线缝合法结合生物补片技术的效果及优势。方法 选取2015年8月至2019年3月间张家口第五医院收治的中低位直肠阴道瘘患者38例,根据治疗方式不同分为新型补片组(n=19)和对照组(n=19)。对照组采用传统的人体黏膜修复术式配合间断缝合治疗方法,新型补片组采用新型生物补片技术结合藏线缝合法的治疗术式,两组连续治疗并在1年后随访,比较两组患者的术后血清炎症因子水平、术后并发症、住院时间及复发率等情况。结果 新型补片组和对照组的术后血清炎症因子CRP(mg/L)、TNF-α(μg/L)、PCT(μg/L)、HMGB-1(μg/L)分别为(68.34±7.65,473.34±62.52,7.35±0.79,8.20±0.93)和(112.21±21.24,524.14±78.23,12.00±1.43,14.71±1.93),新型补片组均显著低于对照组(P<0.05)。新型补片组和对照组的术后并发症发生率分别为5.26%和31.56%,新型补片组明显低于对照组(P<0.05)。两组患者的住院时间无统计学差异(P>0.05)。1年后随访,新型补片组和对照组的复发率分别为5.26%和21.05%,两组差异有统计学意义(P<0.05)。结论 采用藏线缝合法结合生物补片治疗中低位直肠阴道瘘,不仅能解决传统术式中张力大、易感染的问题,而且能有效避免因肛管缺损造成的功能丧失,减少复发。 |
关键词: 藏线缝合法 生物补片 中低位直肠阴道瘘 |
DOI:10.11724/jdmu.2020.03.05 |
分类号:R657.1 |
基金项目:河北省张家口市科技计划外科研项目(1621046D) |
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Clinical study on the hidden line suture repair treatment of middle and low rectovaginal fistulas with biological patch |
WANG Huijuan1, FENG Xiaolan1, WANG Changsheng2, YANG Jun3
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1.Department of Obstetrics and Gynecology, the Fifth Hospital of Zhangjiakou, Zhangjiakou 075000, China;2.Department of Proctology, the Fifth Hospital of Zhangjiakou, Zhangjiakou 075000, China;3.Department of Radiology, the Fifth Hospital of Zhangjiakou, Zhangjiakou 075000, China
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Abstract: |
Objective To investigate the effect and advantage of the combination of suture and biological mesh in the surgical treatment of middle and low rectovaginal fistula. Methods A total of 38 clinical cases of middle and low rectovaginal fistula admitted to the Fifth Hospital of Zhangjiakou between August 2015 and March 2019 were selected and divided into the new patch group (n=19) and the control group (n=19) according to different treatment methods. The control group was treated with traditional human mucosal repair combined with interrupted suture treatment; and the new patch group was treated with new biological patch technique combined with hidden line suture repair. The patients were followed up after 1 year of surgery. The postoperative serum levels of inflammatory cytokines, postoperative complications rate, recurrence rate, and hospitalization time were compared between the two groups. Results The serum inflammatory factors CRP (mg/L), TNF-α (μg/L), PCT (μg/L) and HMGB-1 (μg/L) were (68.34±7.65, 473.34±62.52, 7.35±0.79, 8.20±0.93) and (112.21±21.24, 524.14±78.23, 12.00±1.43, 14.71±1.93) in the new patch group and the control group, respectively. The levels were significantly lower in the new patch group than those in the control group (P<0.05). The incidence of postoperative complications in the new patch group and the control group was 5.26% and 31.56%, respectively (P<0.05). There was no significant difference in hospital stay between the two groups (P>0.05). At 1-year follow-up, the recurrence rates of the new patch group and the control group were 5.26% and 21.05%, respectively (P<0.05). Conclusions In the treatment of middle and low rectovaginal fistula, the combination of suture and biological patch can not only solve the problem of high tension and easy infection in traditional operation, but also effectively avoid the loss of function caused by anal defects and reduce recurrence. |
Key words: hidden line suture repair treatment biological patch middle and low rectovaginal fistulas |