【作者】 雷超；

【导师】 王业皇；

【作者基本信息】 南京中医药大学 ， 中医外科， 2011， 硕士

【摘要】 目的：高位肛瘘尤其是高位复杂性肛瘘的治疗已经被国内外医学界列为现代外科的难题之一。而实挂线法是处理高位肛瘘内口的重要方法之一。通过对改良紧线术与传统紧线术在高位肛瘘实挂线的随机对照研究,我们以选择更好的保护肛门功能的紧线术式治疗高位肛瘘。方法：选择2010年6月至2011年4月在南京市中医院住院的高位肛瘘患者30例,随机分为治疗组和对照组,各15例,其中治疗组采用改良紧线术,对照组采用传统紧线术。按照试验方案对两组患者进行治疗,并分别观察和记录两组术后及紧线术后的创面疼痛,创面分泌物,肛门功能及形态等,并随访三个月。根据观察指标的评分标准进行评分。经统计学处理后,观察两组在疗效、愈合时间、复发率、术后疼痛程度、分泌物的量及肛门功能等方面的差异。结果：本研究表明治疗组与对照组在疗效、疗程、复发率及在紧线术后创面疼痛、创面分泌物的量方面无显著性差异(P>0.05)。两组患者术后肛门功能方面,治疗组在术后1月、2月、3月的肛门失禁评分(Wexner评分)和肛门指诊评分明显优于对照组(P<0.05)。治疗组的肛门缺损深度上在脱线时、术后1月、2月、3月均明显低于于对照组(P<0.05)。而治疗组在术后3月的肛门锁孔样畸形发生率远小于对照组(P<0.05)。结论：改良紧线术在疗效、疗程、复发率等方面及在紧线术后创面疼痛、创面分泌物的量方面与传统紧线术相当,但在保护肛门功能及减轻挂线术对于肛门形态影响方面,改良紧线术具有明显优势。更多还原

【Abstract】 OBJECTIVE:The anal fistula is a familiar anorectal disease, but the therapy of the high anal fistula is very difficult.To seek for the internal orifice is the key of the cure of the disease. Bases of the sphincter cutting seton in the high anal fistula,we use the improved cutting seton to cure the high anal fistula,comparing with the traditional cutting seton randomly. We will elect the better one of protecting the anal funetion in the sphincter cutting seton of the high anal fistula.METHODS:30 patients were divided into therapy group and control group randomly. There are 15 patients in therapy group and 15 patients in control group. The therapy group is treated with the improved cutting seton and the control group with the traditional cutting seton. According to the project, we observe the two groups after operation, and then investigate for three months to half a year. Using these statistic data, we can study the difference in the curative effect、the period of treatment the rate of recurrence、the function of the anal sphincter、the degree of the anal pain、the quantity of the secretion and so on.RESULT:No difference in the curative effect、the period of treatment、the ratio of recurrence、the degree of the anal pain、the quantity of the secretion between the two groups(P>0.05).Through the Wexner score、the finger diagnose, there is a significant difference in the function of the anal sphincter after operation(P<0.05), and in the depth of the anal coloboma, there is a significant difference of off-line、1st month、2nd month and 3rd month after operation (P<0.05). In the rate of the door lock anal taratogenia, there is a significant difference of 3rd month after operation(P<0.05).CONCLUSION:The study indicates that the improved cutting seton to cure high anal fistula is not superior to the control group in the curative effect、the period of treatment the ratio of recurrence、the degree of the anal pain、the quantity of the secretion and so on. But the improved cutting seton is dominant in protecting the function of the anal sphincter and cutting down the influence of the anal-morph with cutting seton.更多还原