肛门内括约肌部分切开结扎术治疗陈旧性肛裂的临床研究

外科理论与实践››2022,Vol. 27››Issue (03): 234-238.doi:10.16139/j.1007-9610.2022.03.010

肛门内括约肌部分切开结扎术治疗陈旧性肛裂的临床研究

郝爽¹, 殷立新¹(), 白利朋²

1.上海中医药大学附属龙华医院肛肠科,上海 200032
2.解放军总医院中医肛肠科,北京 100080

收稿日期:2021-11-03出版日期:2022-06-25发布日期:2022-08-03
通讯作者:殷立新 E-mail:ylx_5111@163.com
基金资助:
浦东新区卫生和计划生育委员会卫生计生科研项目（卫生行业专项R联合攻关项目）(PW2018D-05);上海市进一步加快中医药事业发展三年行动计划(ZY（2018-2020）-CCCX-1007);全国中医学术流派传承工作室第二轮建设项目(国中医药人教函【2019】62号);上海中医药大学附属龙华医院医疗专项（科技创新项目）(CX202025);上海市临床重点专科项目(shslczdzk04301)

Clinical study on lateral internal partial sphincterotomy and ligation in treatment of chronic anal fissure

HAO Shuang¹, YIN Lixin¹(), BAI Lipeng²

1. Department of Anorectum, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai 200032
2. Department of Traditional Chinese Medical Anorectum, Chinese PLA General Hospital, Beijing 100080, China

Received:2021-11-03Online:2022-06-25Published:2022-08-03
Contact:YIN Lixin E-mail:ylx_5111@163.com

摘要/Abstract

摘要：

目的：研究肛门内括约肌部分切开结扎术治疗陈旧性肛裂的临床疗效。方法：160例陈旧性肛裂病人通过随机数字表分成两组。研究组80例采用内括约肌部分切开结扎术。对照组80例采用内括约肌后方切断术。统计两组术后各时间点创面大小、疼痛评分、出血评分、肛门功能及住院时间和切口创面愈合时间。结果：研究组和对照组有效率均100%。研究组治愈率为100%,优于对照组97.5%,差异有统计学意义（P<0.05）。研究组术后第1、3、5、7天创面面积均小于同期对照组,差异有统计学意义（P<0.05）。研究组术后第1、3、5、7天疼痛评分、出血评分、均小于同期对照组,差异有统计学意义（P<0.05）。研究组术后创面愈合后Wexner肛门功能失禁评分低于对照组,差异有统计学意义（P<0.05）。研究组住院时间以及切口创面愈合时间均短于对照组,差异有统计学意义（P<0.05）。结论：肛门内括约肌部分切开结扎术治疗陈旧性肛裂疗效确切安全,具有加速创面愈合、术后出血少、疼痛轻等优势,肛门功能保护良好。

关键词:陈旧性肛裂,肛门内括约肌,内括约肌切开,结扎

Abstract:

ObjectiveTo study the effect of lateral internal partial sphincterotomy and ligation on chronic anal fissure.MethodsA total of 160 patients with chronic anal fissure were randomly divided into two groups. Eighty cases both in study group treated with lateral internal partial sphincterotomy combined with ligation and in control group treated with internal sphincter resection were studied. Incision size, pain score, bleeding score, anal function, hospital stay and incision would healing day on different days after operation in two groups were analyzed.ResultsTreatment efficacy was 100% in both groups. Cure rates was 100% in study group and 97.50% in control group (P<0.05). Incision sizes on the 1st, 3rd, 5th and 7th day after operation in study group were significantly smaller than those same-day in control group(P<0.05). Both pain score and bleeding score on the 1st, 3rd, 5th and 7th day after operation in study group were significantly lower than those same-day in control group (P<0.05). Wexner anal incontinence scores after wound healing in study group were significantly lower than those in control group(P<0.05). Hospital stay and incision wound healing day in study group were less than those in control group significantly (P<0.05).ConclusionsLateral internal partial sphincterotomy and ligation would be effective and safe in treatment of chronic anal fissure with advantages including less days of wound healing, less postoperative bleeding and pain combined with protection of anal function.

Key words:Chronic anal fissure,Internal anal sphincter,Internal sphincterotomy,Ligation

中图分类号:

R657.14

郝爽, 殷立新, 白利朋. 肛门内括约肌部分切开结扎术治疗陈旧性肛裂的临床研究[J]. 外科理论与实践, 2022, 27(03): 234-238.

HAO Shuang, YIN Lixin, BAI Lipeng. Clinical study on lateral internal partial sphincterotomy and ligation in treatment of chronic anal fissure[J]. Journal of Surgery Concepts & Practice, 2022, 27(03): 234-238.

图/表7

图1

失禁情况	很少	有时	常常	总是
干便	1	2	3	4
稀便	1	2	3	4
气体	1	2	3	4
需衬垫	1	2	3	4
生活方式改变	1	2	3	4

表1

组别	疗效（n/%）	有效率	治愈率	P值
研究组（n=80）	80（100）	0	0	100%	100%	<0.01
对照组（n=80）	78（97.5）	2（2.5）	0	100%	97.50%

表2

组别	术后第1天	术后第3天	术后第5天	术后第7天
对照组（n=80）	2	2	1	1
研究组（n=80）	1	0	0	0
P值	<0.01	<0.01	0.046	0.018

表3

组别	术后	出血评分	P值	疼痛评分	P值
对照组	第1天	2	0.034	6	<0.01
研究组	第1天	1		3
对照组	第3天	1	<0.01	4	<0.01
研究组	第3天	0		1
对照组	第5天	1	<0.01	2	<0.01
研究组	第5天	0		0
对照组	第7天	1	<0.01	2	<0.01
研究组	第7天	0		0

表4

组别	Wexner评分	P值
对照组（n=80）	0.31±0.47	0.047
研究组（n=80）	0.01±0.11

表5

组别	住院时间	切口愈合时间	完全愈合时间
对照组（n=80）	6.68±1.42	19.01±2.11	19.01±2.11
研究组（n=80）	3.89±0.80	3.28±0.75	12.41±2.69
P值	P<0.01	P<0.01	P<0.01

表6

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