曾曉梅

【關(guān)鍵詞】肛瘺;虛實(shí)結(jié)合掛線法;一次切開掛線術(shù)

【中圖分類號(hào)】R657.1 【文獻(xiàn)標(biāo)識(shí)碼】B 【文章編號(hào)】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

肛瘺屬于較為常見肛腸類疾病之一，主要是由于患者直腸與肛門和內(nèi)口之間的管道與腔感染所致[1]。但是在臨床研究中我們發(fā)現(xiàn)，出現(xiàn)復(fù)雜性肛瘺的患者往往會(huì)出現(xiàn)肛周膿腫，傳統(tǒng)治療方法往往采用分期治療的方法進(jìn)行手術(shù)治療，但是隨著臨床研究的加深，我們發(fā)現(xiàn)分期手術(shù)治療往往會(huì)延長患者的治療時(shí)間，不利于患者日常生活的有效回歸。臨床有文獻(xiàn)指出[2]，分期手術(shù)治療患者的復(fù)雜性肛瘺合并肛周膿腫往往會(huì)使得患者的術(shù)后并發(fā)癥增多的情況。針對(duì)于這一現(xiàn)狀，我院特選取50例在我院進(jìn)行瘺管外切+松掛線手術(shù)的患者作為本次研究對(duì)象，探討在復(fù)雜性肛瘺合并肛周膿腫的治療中，分期、同期瘺管外切+松掛線手術(shù)的臨床治療價(jià)值比較，報(bào)告如下：

1 資料與方法

1.1 一般資料

選取50例在我院進(jìn)行瘺管外切+松掛線手術(shù)的患者作為本次研究對(duì)象，患者治療時(shí)間為2016年6月至2019年8月，按照兩次手術(shù)時(shí)間的不同分為同期手術(shù)組與分期手術(shù)組，兩組各分配患者25例。同期手術(shù)組25例患者中，男性15例，女性10例，年齡23～62歲，中位年齡（42.4±1.2）歲;分期手術(shù)組25例患者中，男性15例，女性10例，年齡22～63歲，中位年齡（41.9±1.3）歲，兩組患者基線資料基本無差別（P>0.05）.

1.2 手術(shù)方法

為同期手術(shù)組患者選擇同期瘺管外切+松掛線手術(shù)治療，具體步驟如下：①術(shù)前1d禁止飲食，服用緩瀉藥并進(jìn)行清潔灌腸;②患者麻醉完成后，選擇折刀位進(jìn)行手術(shù)，消毒后進(jìn)行鋪單;③將患者的膿腫中心切開并進(jìn)行排膿操作，待排盡膿液后向患者的膿腫識(shí)別主管內(nèi)口進(jìn)行雙氧水與亞甲藍(lán)染料注入，并通過內(nèi)口為患者的肛管內(nèi)進(jìn)行注入;③隨后通過內(nèi)口對(duì)于患者的肛管內(nèi)進(jìn)行開放膿腔，并通過對(duì)于患者的硬結(jié)和瘺遠(yuǎn)端進(jìn)行牽引膿腔開放;④在對(duì)于患者的內(nèi)口進(jìn)行確定后，采用電刀順著瘺道硬索向進(jìn)行肛門括約肌剝離，剝離方法采用隧道式剝離并將患者的部分瘺道進(jìn)行切除[3];⑤對(duì)于支管過于深的患者掛線采用對(duì)口引流的方式，內(nèi)口部位的掛線以“松掛”為主，同時(shí)在術(shù)中要格外注意對(duì)于患者肛門括約肌的保護(hù)。