【作者】 王新民；

【导师】 谢力子；

【作者基本信息】 湖南中医学院 ， 中医肛肠外科， 2002， 硕士

【摘要】 目的：本课题旨在通过系统的临床观察和实验研究，探讨开窗旷置术治疗高位复杂性肛瘘的临床疗效及机理。 方法：将60例高位复杂性肛瘘患者随机分为开窗旷置术组(治疗组)和切开挂线术组(对照组)进行临床疗效的观察和对比，并对每组中的20例患者进行手术前后肛管直肠压力，肛门外括约肌肌电图及直肠感觉与肛门节制功能的对比。 结果：1、开窗旷置术治疗高位复杂性肛瘘能明显缩短创面愈合时间，减少肛门周围组织的损伤，减少术后并发症，远期肛门括约功能良好，明显优于切开挂线术。 2、开窗旷置术术后肛管最大收缩压，肛管静息压，肛管舒张压，肛门外括约肌静息波幅，大力收缩波幅，直肠阈值量，直肠恒定量，肛门首漏量，肛门保留量均降低，但下睁幅度明显小于切开挂线术(P＜0.01)。肛管最长收缩时间缩短，但缩短幅度明显小于切开挂线术(P＜0.01)。 结论：开窗旷置术是治疗高位复杂性肛瘘的一种理想术式，该术式是利用肛肠动力学原理，通过彻底清除原发病灶，减少对肛门括约肌及周围组织的损伤来保护肛门括约功能。更多还原

【Abstract】 Objective: To evaluate the curative effect of the fenestration and putting aside therapy on HCAF and to discuss its mechanism by systematic clinical and experiment study.Methods: Sixty cases of patients were divided randomly into the control group and the treatment group. The former was treated with incision and thread-drawing therapy, and the latter with fenestration and putting aside. A comparative study on clinical curative effect between the control group and the treatment group was conducted by examining the anorectal manometry, MEG of external sphincter muscle of anus, the rectal sensory function and the anal continence function in 20 cases selected from each group randomly.Results:1.Fenestration and Putting aside therapy could shorten the recovery time of the wound, decrease the damage of crissal tissue and postoperative complication, and have a satisfactory long-term function of anal sphincter. It was better than the incision and thread-drawing therapy.2.The items in both groups such as the postoperative anal maximal contraction pressure, the anal rest pressure, the anal relaxant pressure, the amplitude of quiescent wave, the maximal contractile wave of external sphincter of anus, the rectal sensory threshold, the rectal constant volume, thetreatment group had a less declined range compared with the control group(P<0.01). The anal longest contraction time decreased too in both groups but the treatment group was better than the control group(P<0.01).Conclusion: Fenestration and putting aside therapy is a satisfactory surgical method in the treatment of HCAF. It makes use of the anorectal dynamics, and can clean the primary focus of disease thoroughly, protect the function of anal sphincter muscle by reducing the damage of anal sphincter muscle and crissal tissue.更多还原