曾晓梅

【关键词】肛瘘;虚实结合挂线法;一次切开挂线术

【中图分类号】R657.1 【文献标识码】B 【文章编号】1002-8714（2020）06-0046-01

【Abstract】 Objective： To explore the clinical value of stage， simultaneous fistulectomy + thread loosening operation in the treatment of complex anal fistula with perianal abscess. Methods： 50 patients who underwent fistulectomy + thread loosening surgery in our hospital were selected as the subjects of this study. The treatment time of the patients was from June 2016 to August 2019. According to the different time of the two operations， they were divided into the same period operation group and the staged operation group， with 25 patients in each group. The patients in the two groups were compared after the treatment. Results： comparing the operation time， average hospitalization time， wound healing time and postoperative complications of the two groups， we found that the operation time， average hospitalization time， wound healing time and postoperative complications of the operation group at the same time were significantly better than that of the staged operation group， and the difference between the two groups was significant （P < 0.05）. Conclusion： in the treatment of complex anal fistula with perianal abscess， the clinical treatment effect of simultaneous fistulectomy + thread loosening operation is significantly higher than that of staged fistulectomy + thread loosening operation， which can effectively reduce the postoperative complications of patients， improve the postoperative recovery effect of patients and improve the safety of the country， which is worth promoting.

【Key words】 anal fistula; deficiency and excess combined with thread hanging; one-time incision and thread hanging

肛瘘属于较为常见肛肠类疾病之一，主要是由于患者直肠与肛门和内口之间的管道与腔感染所致[1]。但是在临床研究中我们发现，出现复杂性肛瘘的患者往往会出现肛周脓肿，传统治疗方法往往采用分期治疗的方法进行手术治疗，但是随着临床研究的加深，我们发现分期手术治疗往往会延长患者的治疗时间，不利于患者日常生活的有效回归。临床有文献指出[2]，分期手术治疗患者的复杂性肛瘘合并肛周脓肿往往会使得患者的术后并发症增多的情况。针对于这一现状，我院特选取50例在我院进行瘘管外切+松挂线手术的患者作为本次研究对象，探讨在复杂性肛瘘合并肛周脓肿的治疗中，分期、同期瘘管外切+松挂线手术的临床治疗价值比较，报告如下：

1 资料与方法

1.1 一般资料

选取50例在我院进行瘘管外切+松挂线手术的患者作为本次研究对象，患者治疗时间为2016年6月至2019年8月，按照两次手术时间的不同分为同期手术组与分期手术组，两组各分配患者25例。同期手术组25例患者中，男性15例，女性10例，年龄23～62岁，中位年龄（42.4±1.2）岁;分期手术组25例患者中，男性15例，女性10例，年龄22～63岁，中位年龄（41.9±1.3）岁，两组患者基线资料基本无差别（P>0.05）.

1.2 手术方法

为同期手术组患者选择同期瘘管外切+松挂线手术治疗，具体步骤如下：①术前1d禁止饮食，服用缓泻药并进行清洁灌肠;②患者麻醉完成后，选择折刀位进行手术，消毒后進行铺单;③将患者的脓肿中心切开并进行排脓操作，待排尽脓液后向患者的脓肿识别主管内口进行双氧水与亚甲蓝染料注入，并通过内口为患者的肛管内进行注入;③随后通过内口对于患者的肛管内进行开放脓腔，并通过对于患者的硬结和瘘远端进行牵引脓腔开放;④在对于患者的内口进行确定后，采用电刀顺着瘘道硬索向进行肛门括约肌剥离，剥离方法采用隧道式剥离并将患者的部分瘘道进行切除[3];⑤对于支管过于深的患者挂线采用对口引流的方式，内口部位的挂线以“松挂”为主，同时在术中要格外注意对于患者肛门括约肌的保护。