经肛门直肠黏膜瓣推移术与经肛括约肌间切开术治疗复杂性肛瘘的效果及对肛管直肠压力的影响
Effect of transanal mucosal flap displacement and transanal intersphincterotomy on the treatment of complex anal fistulas and their influence on the pressure of anorectal canal
熊健 1谢华辉 1何文涛 2李明堃 2沈明 1张仁浩 1牛天峰 1罗靖1
作者信息
- 1. 443000 湖北宜昌,三峡大学第三临床医学院·国药葛洲坝中心医院普外科
- 2. 湖北省荆州市中医医院普外科
- 折叠
摘要
目的 探讨经肛门直肠黏膜瓣推移术(endoanal advancement flap,ERAF)与经肛括约肌间切开术(transanal opening of intersphincteric space,TROPIS)治疗复杂性肛瘘的效果及对肛管直肠压力的影响.方法 2018年10月～2022年10月收治的复杂性肛瘘病人84例,按治疗方法分为ERAF治疗组(E组,48例)和TROPIS治疗组(T组,36例).比较两组临床疗效、手术情况、创面情况以及肛管直肠压力.结果 T组治疗有效率为97.22％,高于E组的87.50％,但差异无统计学意义(P＞0.05).T组手术时间为(31.53±7.29)分钟,术中出血量为(29.56±7.37)ml,手术当天、术后7天和14天创面面积分别为(10.03±0.96)cm2、(8.76±0.87)cm2和(6.20±0.77)cm2,E 组分别为(35.36±8.54)分钟、(36.86±8.04)ml、(12.09±1.23)cm2、(10.52±1.09)cm2和(7.36±0.85)cm2,两组比较差异有统计学意义(P＜0.05).T组术后VAS评分、Wexner失禁评分分别为(1.38±0.27)分和(0.21±0.08)分,E 组分别为(1.56±0.29)分和(0.33±0.09)分,T组20 mm处、30 mm处肛管直肠收缩压和20 mm处、30 mm处肛管直肠静息压分别为(138.18± 29.58)mmHg、(136.22±35.41)mmHg、(35.47±6.58)mmHg 和(32.97±8.01)mmHg,E 组分别为(152.78±31.53)mmHg、(156.29±32.74)mmHg、(38.29±7.62)mmHg、(36.41±7.63)mmHg,两组评分和肛管直肠压力均下降,且T组低于E组,两组比较差异有统计学意义(P＜0.05).E组不良反应发生率(20.83％)高于F组的(13.89％),但差异无统计学意义(P＞0.05).结论 TROPIS治疗复杂性肛瘘的效果更好,能缩减手术时间,减少术中出血量,减轻术后疼痛,保护肛门功能.
Abstract
Objective To explore the effect of Endoanal advancement flap(ERAF)and transanal opening of interphincteric space(TROPIS)in the treatment of complex anal fistula and their impact on anorectal pressure,so as to provide a reference for clinical selection of surgical methods.Methods Eighty-four patients with complex anal fistula admitted from October 2018 to October 2022 were divided into group E received ERAF treatment(n=48)and group T received TROPIS treatment(n=36).The clinical efficacy,operation,wound surface and anorectal pressure of the two groups were compared.Results The effective rate of treatment in Group T was 97.22％,which was higher than that in Group E(87.50％),with no statistically significant difference(P＞0.05).The surgical time[(31.53 ±7.29)minutes],intraoperative bleeding volume[(29.56±7.37)ml],and wound area[(10.03± 0.96)cm2,(8.76±0.87)cm2,(6.20±0.77)cm2]on the day of surgery,7 and 14 days after surgery in Group T were all smaller than those in Group E[(35.36±8.54)min,(36.86±8.04)ml,(12.09± 1.23)cm2,(10.52±1.09)cm2 and(7.36±0.85)cm2](P＜0.05).After surgery,the VAS score and Wexner incontinence score of Group T were(1.38±0.27)and(0.21±0.08),respectively.Group E was(1.56±0.29)and(0.33±0.09),respectively.In group T,the anorectal systolic pressure at 20 mm and 30 mm and the anorectal resting pressure at 20 mm and 30 mm were(138.18±29.58)mmHg,(136.22±35.41)mmHg,(35.47±6.58)mmHg,and(32.97±8.01)mmHg,respectively.In Group E,the data was(152.78±31.53)mmHg,(156.29±32.74)mmHg,(38.29±7.62)mmHg and(36.41±7.63)mmHg,respectively.Both groups showed a decrease in score and anorectal pressure,and group T was lower than group E(P＜0.05).The incidence of adverse reactions in Group E was 20.83％,which was higher than that in Group T(11.11％),but the difference was not statistically significant(P＞0.05).Conclusion TROPIS has a better effect in the treatment of complex anal fistula,which can shorten the operation time,reduce intraoperative bleeding,reduce postoperative pain,and protect anal function.
关键词
经肛门直肠黏膜瓣推移术/经肛括约肌间切开术/复杂性肛瘘/直肠/肛管Key words
endoanal advancement flap/transanal opening of intersphincteric space/complex anal fistula/rectum/anal canal引用本文复制引用
出版年
2024
NETL
NSTL
万方数据