樊鹏　　徐红丽　　王凯　　马冲

[關键词] 复杂性肛瘘;括约肌间结扎术;黏膜瓣推移术;肛门直肠瘘

[中图分类号] R657.1          [文献标识码] B          [文章编号] 1673-9701（2021）16-0075-04

Comparison of the clinical effects of intersphincteric fistula ligation and mucosal flap advancement in the treatment of complex anal fistula

FAN Peng   XU Hongli   WANG Kai   MA Chong

Department of Colorectal Hernia Surgery， Binzhou Medical University Hospital， Binzhou   256603， China

[Abstract] Objective To explore the postoperative effectiveness of intersphincteric fistula ligation and mucosal flap advancement in the treatment of complex anal fistulas. Methods A total of 95 patients who underwent complex anal fistula surgery in our hospital from October 2017 to September 2019 were collected and divided into two groups. The LIFT group （53 cases） was treated with intersphincter ligation， and the ERAF group underwent transanorectal mucosal transfer surgery. The operation time， postoperative pain VAS score and postoperative wound healing time were compared between the two groups. The postoperative effectiveness between the two surgical methods was evaluated. Results The operation time and postoperative wound healing time of the ERAF group were longer than those of the LIFT group， and the difference was statistically significant （P=0.000）. The postoperative VAS score of the ERAF group was lower than that of the LIFT group （P=0.000）. In the LIFT group， 49 cases were effective and 4 cases were ineffective， with an effective rate of 92.45%. In the ERAF group， 39 cases were effective and 3 cases were ineffective， with the total of effective rate of 92.86%. There was no statistically significant comparison of the effective rates of the two surgical methods at 3 months after operation（P>0.05）. The postoperative effective rate of the two surgical methods was not statistically significant（P>0.05）. In the LIFT group， 50 cases were followed up three months after the operation， of which 44 cases were effective， 6 cases were ineffective， and the total of effective rate was 88.00%. In the ERAF group， 39 cases were followed up effectively， of which 33 cases were effective， and 6 cases were ineffective， and the total of effective rate was 84.62%. There was no statistically significant difference in the effective rates of the two surgical methods at three months after operation（P>0.05）. Conclusion Both LIFT and ERAF for complex anal fistula surgery can achieve a good curative effect.

[Key words] Complex anal fistula; Intersphincter ligation; Mucosal flap advancement; Anorectal fistula

肛门直肠瘘是好发于男性的一种良性病变，通常由于肛周脓肿导致异常通道在直肠下端或肛门周边形成，严重影响患者的生活质量[1]。临床上通常将其分为单纯性与复杂性，复杂性肛门直肠瘘一般指病变存在2个以上的内或外瘘口，并且含有数量>2个的瘘管或支管[2]。对于复杂性肛瘘的治疗主要依靠手术治疗，目前临床广泛应用由Rojanasakul[3]提出的括约肌间瘘管结扎术（Ligation of intersphincteric fistula tract，LIFT）进行治疗，并取得了良好的疗效。其他保留肛门的术式还有黏膜瓣推移术（Endoanal advancement flap，ERAF）、干细胞填充、肛瘘镜视频辅助等疗法。由于手术方式多样，对于不同的患者选用更加合理的手术方式尤为重要，本研究旨在对括约肌间瘘管结扎术与经肛门直肠黏膜瓣推移术治疗复杂性肛瘘的临床效果进行分析，为复杂性肛瘘的手术方式选择提供参考，现报道如下。

1 资料与方法

1.1 一般资料

收集2017年10月至2019年9月在我院行复杂性肛瘘手术治疗的患者95例，所有患者均在术前获得知情同意，术前向所有患者充分说明两种手术的手术方式及细节，施行何种手术方式由患者自愿选择。纳入标准：所入选患者均符合复杂性肛瘘的诊断标准[4]，并且处于临床炎症静止期，且内或外瘘口数量大于等于2个，病程≥3个月。排除标准[5]：排除伴有严重全身慢性疾病、克罗恩病、结核病、肠道恶性肿瘤等患有其他肠道疾病影响肛瘘治疗的患者，排除精神性疾病，妊娠等不宜施行肛瘘手术者。根据手术……