王悦辉+肖依珠

[摘要]目的 比较传统手术方式与改良LIFT术式治疗肛瘘的临床疗效。方法 选取2011年1月～2015年1月本院收治的200例肛瘘患者作为研究对象，根据手术方式分为传统手术组和改良LIFT手术组，各100例。传统手术组给予肛瘘切除术，改良LIFT组给予LIFT术式治疗，比较两组的术后疼痛持续时间、出血持续时间、切口愈合时间、肛门功能以及临床疗效。结果 改良LIFT组的治疗总有效率为98.0%，显著高于传统手术组的81.0%，差异有统计学意义（P<0.05）。改良LIFT组术后1、3、7 d的疼痛评分显著低于传统手术组，住院时间显著短于传统手术组，差异有统计学意义（P<0.05）。改良LIFT组的创面愈合时间显著短于传统手术组，术后1、2个月的FISI评分显著低于传统手术组，差异有统计学意义（P<0.05）。改良LIFT组术后的不良反应发生率为3.0%，显著低于传统手术组的12.0%，差异有统计学意义（P<0.05）。两组随访3～6个月，期间均无肛门狭窄变形、肛门缺损及肛门移位等后遗症。结论 与传统的肛瘘切除手术相比，改良LIFT手术能够提高临床疗效，缩短术后疼痛时间以及出血时间，促进切口愈合，降低术后复发率，值得临床推广应用。

[关键词]肛瘘；肛瘘切除手术；改良括约肌间瘘管结扎术

[中图分类号] R657.1+6 [文献标识码] A [文章编号] 1674-4721（2016）06（c）-0038-04

[Abstract]Objective To compare the clinical effect of traditional method and modified LIFT procedure in the treatment of anal fistula.Methods 200 patients with anal fistula from January 2011 to January 2015 in our hospital were selected and divided into the traditional surgery group and the modified LIFT surgery group according to surgical method，100 cases in each group.The traditional surgery group was given anal fistula resection，and the modified LIFT surgery group was given LIFT procedure.The duration of postoperative pain，duration of bleeding，healing time of incision，anal function and clinical efficacy of the two groups was compared.Results The total effective rate of the modified LIFT surgery group was 98.0%，which was higher than 81.0% of the traditional surgery group，with significant difference （P<0.05）.The pain score after operation at 1，3，7 days in the modified LIFT surgery group was lower than that in the traditional surgery group，hospital stay in the modified LIFT surgery group was shorter than that in the traditional surgery group，with significant difference （P<0.05）.The healing time of incision in the modified LIFT surgery group was shorter than that in the traditional surgery group，the FISI score after operation at 1，2 months in the modified LIFT surgery group was lower than that in the traditional surgery group，with significant difference （P<0.05）.The incidence rate of adverse reaction in the modified LIFT surgery group was 3.0%，which was lower than 12.0% of the traditional surgery group，with significant difference （P<0.05）.The two groups were followed up for 6 to 3 months，there were no complications such as anal stenosis，anal defect and anal displacement.Conclusion Compared with the traditional anal fistula surgery，the modified LIFT surgery can improve the clinical curative effect，shorten postoperative pain and bleeding time，promote wound healing，reduce the recurrence rate，it is worthy of clinical promotion and application.

[Key words]Anal fistula；Anal fistula surgery；Modified intersphincteric fistula ligation

肛瘘是肛肠科常见的难治性疾病之一，治疗方法首选手术，但术后复发率高且易引发肛门失禁，故一直是肛瘘治疗中的难题[1-2]。传统的肛瘘手术主要为切开治疗，包括瘘管切开术和肛瘘切除术（辅助或不辅助挂线疗法），其他方法如瘘管旷置术、经肛直肠黏膜瓣前徙修补及分期瘘管切开术等。传统术式能够相对彻底地对病灶进行处理，复发率较低，但因切开肛门括约肌，易损伤肛门功能，严重影响患者的生活质量[2]。目前的括约肌保留术如内口封闭管道旷置法、生物胶封堵法等虽减少了括约肌损伤，保护了肛门功能，但病灶清理不彻底，治愈率低，复发率偏高[3-4]。寻找治愈率高并能充分保护肛门功能的术式已成为目前肛瘘治疗中的热点。2007年，Arun等提出了括约肌间瘘管结扎术（ligation of intersphincteric fistula tract，LIFT），该术式经括约肌间沟入路，游离并结扎瘘管。封闭内口，对远侧瘘管进行搔刮清理并旷置。……