胡海平 陈喜丽

[摘要] 目的 研究单纯性经括约肌型肛瘘的手术改良方案，并探讨其应用价值，以指导临床疾病的治疗。 方法 选取2013年1月～2015年1月于我院接受治疗的单纯性经括约肌型肛瘘患者56例，随机均分为两组：对照组行经括约肌间瘘管结扎术（ligation of the intersphinctericfistula tract，LIFT术），观察组行改良LIFT术治疗。比较两组手术时间、术后疼痛评分、术后住院时间、肛瘘治愈率，随访统计手术前及手术后3个月时患者肛管静息压及最大收缩压变化。 结果 观察组治愈率明显高于对照组，差异有统计学意义（P<0.05）；两组手术时间、术后疼痛评分、术后住院时间、手术前及手术3个月后肛管静息压及最大收缩压接近，差异无统计学意义（P>0.05）。 结论 改良LIFT术能在保证手术效果及肛门功能的基础上，显著提升单纯性经括约肌型肛瘘的治愈率，值得推广。

[关键词] 经括约肌型肛瘘；经括约肌间瘘管结扎术；改良；肛瘘

[中图分类号] R671.5 [文献标识码] B [文章编号] 1673-9701（2015）34-0043-03

Analysis of application value and operation improvement scheme of the simple sphincter anal fistula

HU Haiping CHEN Xili

Department of Anus-Intestines， the First Affiliated Hospital of Hunan Chinese Traditional Medicine University， Changsha 410000， China

[Abstract] Objective To study the operation improvement scheme of simple the sphincter anal fistula and to explore its application value in order to guide the clinical treatment of the disease. Methods A total of 56 cases of patients with simple sphincter anal fistula treated in our hospital from January 2013 to January 2015 were selected and were randomly divided into two groups， the patients in the control group were given ligation of intersphincteric fistula tract （LIFT） while a certain improvement on LIFT in the observation group was performed. The operation time， postoperative pain score， postoperative hospitalization time and anal fistula cure rate in two groups were compared. Three follow-up statistics of changes in patients with anal resting pressure and maximum systolic blood pressure were also compared before the surgery and three months after the surgery. Results The cure rate in the observation group was significantly higher than that of the control group， the difference was significant（P<0.05）. In the two groups， the operation time， postoperative pain score， postoperative hospitalization time and anal resting pressure and maximum systolic blood pressure before operation and 3 months after operation were close enough， the difference was not significant（P>0.05）. Conclusion The application of improved LIFT surgery scheme can guarantee the surgical outcome and can significantly improve the cure rate of anal sphincter at the base of anal function， which is worthy of promotion.

[Key words] Sphincter anal fistula； Ligation of intersphincteric fistula tract； Improvement； Archosyrinx

肛瘘是外科常见难治性疾病，临床不仅需治愈瘘管，同时还应尽可能避免破坏患者肛门功能[1]，部分患者瘘管穿过括约肌，治疗尤为困难。2007年泰国华裔医生Rojanasakul介绍了一种新的手术方案[2]，即括约肌间瘘管结扎术（ligation of the intersphinctericfistula tract， LIFT术），该术式能够完整保留肛门括约肌，且可显著降低术后疼痛，然而手术切口小而深，易导致感染及裂开，同时部分持续性肛瘘患者可能复发形成括约肌间肛瘘。为解决上述问题，我院对LIFT术做出一定改进，临床应用提示效果确切，现报道如下。

1 资料与方法

1.1 一般资料

纳入2013年1月～2015年1月于我院接受治疗的单纯性经括约肌型肛瘘患者56例，均经肛周MRI确诊，内、外括约肌功能无明显异常，非急性发作，排除结核性肛瘘、皮下瘘、复杂性肛瘘及合并糖尿病、高血压患者。……