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目的探讨复杂肛瘘的最佳手术治疗方法。方法将192例复杂肛瘘患者随机分为微创(经括约肌间隙入路)手术组和切开切除手术组。观察两组手术时间、术后创面出血情况、术后疼痛、创面愈合时间、肛门瘢痕大小、肛门畸形、肛门功能状况以及术后复发情况。结果微创手术组与切开切除组比较,手术时间缩短犤(36.5±15.3)min,P<0.05犦;术中及术后渗血时间短犤(2.0±0.5)d,P<0.05犦;术后疼痛持续时间短犤(1.5±0.5)d,P<0.05犦,创面愈合时间短犤(18.5±5.5)d,P<0.05犦;肛门瘢痕小犤(3±2)cm2,P<0.05犦;肛门畸形发生率低(5.2%,P<0.01);肛门部分失禁发生率低(2.1%,P<0.01);但术后复发率两者差异并无统计学意义(P>0.05)。结论经括约肌间隙微创手术治疗复杂肛瘘效果较切开切除为佳。
Objective To explore the best surgical treatment of complex anal fistula. Methods A total of 192 patients with complicated anal fistula were randomly divided into minimally invasive (sphincterotomy approach) surgery group and open resection surgery group. The operation time, postoperative wound bleeding, postoperative pain, wound healing time, anal scar size, anus deformity, anus functional status and postoperative recurrence were observed. Results Compared with the resection group, the operation time was shortened by (36.5 ± 15.3) min (P <0.05), and the bleeding time was (2.0 ± 0.5) d after operation and postoperatively, P <0.05 犦. The duration of postoperative pain was shorter (1.5 ± 0.5) d, P <0.05 犦, wound healing time was shorter 犤 (18.5 ± 5.5) d, P <0.05 犦; anal scar was (3 ± 2) The incidence of anal deformity was low (5.2%, P <0.01). The incidence of anal partial incontinence was low (2.1%, P <0.01). However, there was no significant difference in postoperative recurrence between the two groups (P> 0.05). Conclusions The minimally invasive surgery via sphincter gap is better than incision and resection for the treatment of complex anal fistula.