目的 观察保留括约肌挂线法和瘘管切除术治疗复杂性肛瘘的临床效果。方法 选择2010年10月—2013年10月期间收治的复杂性肛瘘患者共122例,并随机均分为A、B两组。其中A组采用保留括约肌挂线法,B组采用瘘管切除术,比较两组患者的近远期治愈率、愈合时间以及后遗症的发生情况。结果 两组患者分别采用保留括约肌挂线法和瘘管切除治疗后均达到治愈标准,近期治愈率及复发率两组间无统计学差异。术后情况,A组愈合时间为(20.74±5.62)天,B组为(19.19±6.84)天,P>0.05,组间无统计学差异,但A组中后遗症的发生率为3.28%,B组中的后遗症发生率为37.70%,χ²=14.182,P<0.05,A组中后遗症的发生率明显低于B组。结论 保留括约肌挂线法与瘘管切除术均能很好地治疗肛瘘,其中保留括约肌挂线法在保存肛门正常生理功能,减少术后后遗症发生等方面较后者有优势,值得临床推广。

Objective To observe the effect of sphincter preservation seton applied in complex anal fistulas treatment. Methods 122 cases of patients with complex anal fistulas treated from October 2010 to 2013 were selected and divided into A and B group randomly and equally. And sphincter preservation seton was applied in A group, while fistula resection applied in B group. The cure rate of short and long term, healing time and occurrence of sequel were compared. Results Standard cure was got in both groups, and there were no statistically significant difference between the cure rates and recurrence rates of short term in the 2 groups. Healing time in A group was (20.74±5.62) days, and (19.19±6.84) days in B group (P>0.05), and no statistically significant difference was between the 2 groups. Occurrence of sequel was 3.28% in A group, while 37.70% in B group, (χ²=14.182, P<0.05), and the occurrence of sequel in A group was much lower than that in B group. Conclusion Complex anal fistulas could be treated well by both sphincter preservation seton and fistula resection, and normal physiological function of anus could be better retained by sphincter preservation seton, and the superiority of reduction of postoperative sequelae was apparent by former surgical. It was worthy of clinical use.

目的 比较改良LIFT术(经括约肌间瘘管结扎术)和常规LIFT术治疗单纯性经括约肌型肛瘘的临床疗效。方法 2013年1月—2014年12月,86例单纯性经括约肌型肛瘘患者,随机分成A组和B组,分别接受改良LIFT 术(A组)与常规LIFT术(B组)42例和44例。通过比较两组病例的手术时间、术后疼痛VAS评分、伤口愈合时间、住院时间及治愈率评估两种手术方法的临床疗效。所有随访患者于术后第3个月均测定肛门直肠压力和进行盆底肌电图检查以评估肛门功能。结果 所有患者均获得随访3个月～26个月,平均(8.73±7.15)月。两组患者的手术时间、术后24 h VAS疼痛评分和住院时间比较,差异无统计学意义(P>0.05)。两组患者的伤口愈合时间比较,差异无统计学意义(P>0.05)。但A组治愈率为88.10%,高于B组治愈率63.63%,差异有统计学意义(P<0.05)。两组患者术前和术后3个月的肛门直肠压力无变化,差异无统计学意义(P>0.05);两组患者术前和术后3个月的内、外括约肌和耻骨直肠肌MUP 平均时限比较,差异均无统计学意义(P>0.05)。结论 改良LIFT术较常规LIFT术提高治愈率,是治疗单纯性经括约肌型肛瘘的有效术式。