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目的 :提高高位复杂性肛瘘的治疗效果 ,减少复发率 ,保护肛门括约肌 ,保护肛门感觉和自制功能。方法 :设计一种具有中西医结合特色的“切开、挂线、选择性缝合”术式治疗高位复杂性肛瘘 ,按全国高位复杂性肛瘘诊断标准及排除标准纳入病例 168例。随机分为 :观察组 86例用“切开、挂线、选择性缝合”术式 ,对照组 82例用切开挂线开放引流术。两组病例均于术前和术后 6个月随访期内用直肠灌注法检测直肠感觉和肛门节制功能。结果 :经术后和术后 6个月随访期的观察 ,观察组 86例全部一次性治愈 ,一次性治愈率 10 0 % ,随访期内 1(1 16% )例出现污染内裤 ,余未发现明显并发症及后遗症 ,肛门功能良好。平均疗程 2 6± 2 8天 ;对照组一次性治愈 69例 ,一次性治愈率 84 15 % ,13 (15 9% )例经 2次手术治疗 ,随访期内 1(1 2 % )例复发 ,术后肛门皮肤缺损 8例 (9 8% ) ,稀便失禁 2例 (2 44 % ) ,污染内裤 11例 (13 41% ) ,平均疗程 3 8± 6 7天。直肠感觉和肛门节制功能检测结果 :两组术前比较 ,P >0 0 5 ;试验组术前术后比较 ,P >0 0 5 ;两组术后比较 ,P <0 0 5 ;对照组术前术后比较 ,P <0 0 5。结论 :与对照组相比 ,本疗法具有疗效好 ,痛苦小 ,疗程短 ,对直肠感觉和肛门节制功能损伤小 ,并发症和后遗症
Objective: To improve the therapeutic effect of high complex anal fistula, reduce the recurrence rate, protect the anal sphincter, protect the anal sensation and self-made function. Methods: A kind of “incision, hook thread and selective suture” operation with high integration of traditional Chinese and western medicine was designed to treat the high complex anal fistula. 168 patients were enrolled according to the diagnostic criteria and exclusion criteria of the national high complexity anal fistula. Randomly divided into: observation group of 86 cases with “incision, hanging line, selective suture” operation, 82 cases of control group open incision with drainage. The two groups of patients were tested by rectal perfusion in the preoperative and postoperative 6 months follow-up rectal sensation and anal function. Results: After 6 months follow-up and postoperative follow-up observation, 86 cases in the observation group were all cured at one time. The one-time cure rate was 100%. In the follow-up period, 1% (1 16% Obvious complications and sequelae, anal function is good. The mean duration of treatment was 26 ± 28 days. In the control group, 69 cases were cured at one time. The one-time cure rates were 84.15% and 13 (15.9%) cases were treated by 2 surgeries. One (12% Postoperative anal skin defects in 8 cases (9 8%), incontinence in 2 cases (2 44%), contaminated underwear in 11 cases (13 41%), the average course of 38 ± 6 7 days. Rectal sensation and anal abstinence function test results: preoperative comparison between the two groups, P> 0.05; experimental group before and after surgery, P> 0.05; two groups after surgery, P <0 05; control group Before and after surgery, P <0 05. Conclusion: Compared with the control group, this therapy has the advantages of good curative effect, little pain, short course of treatment, less damage to the rectum sensation and anus control, complications and sequelae