本文選題：肛瘺 + 濕熱下注�。� 參考：《廣州中醫(yī)藥大學(xué)》2017年碩士論文

【摘要】：目的:肛瘺是臨床常見病,手術(shù)是治療肛瘺的主要方法,術(shù)后創(chuàng)面常愈合緩慢。通過觀察比較肛瘺切除術(shù)聯(lián)合肛門皮膚移植術(shù)與肛瘺切除術(shù)兩種術(shù)式治療濕熱下注型低位單純性肛瘺的臨床療效及手術(shù)安全性,為肛瘺切除術(shù)聯(lián)合肛門皮膚移植術(shù)應(yīng)用于肛痿的治療提供一定的實(shí)踐基礎(chǔ),為濕熱下注型低位單純性肛瘺提供一種安全有效的治療方法。方法:選取濕熱下注型低位單純性肛瘺患者27例,用隨機(jī)數(shù)字表法將患者隨機(jī)分配到觀察組和對(duì)照組,觀察組行肛痿切除術(shù)聯(lián)合肛門皮膚移植術(shù),對(duì)照組行肛瘺切除術(shù),分別觀察兩組手術(shù)時(shí)間、住院時(shí)間、愈合時(shí)間、治愈率、復(fù)發(fā)率等療效指標(biāo)和術(shù)后疼痛程度、出血程度及尿潴留發(fā)生率等安全指標(biāo),比較兩組療效及安全性。結(jié)果:1.手術(shù)時(shí)間比較:觀察組患者手術(shù)時(shí)間為(62±18)min,對(duì)照組為(38±11)min,兩組比較,差異有統(tǒng)計(jì)學(xué)意義(t=4.34,P0.05)。2.住院時(shí)間比較:觀察組患者住院時(shí)間為(6.8±1.2)d,對(duì)照組住院時(shí)間為(5.6±2.6)d,兩組住院時(shí)間相當(dāng),差異無統(tǒng)計(jì)學(xué)意義(p0.05)。3.愈合時(shí)間比較:觀察組愈合時(shí)間為(14.4±3.2)d,對(duì)照組愈合時(shí)間為(38.7±13.6)d,觀察組愈合時(shí)間顯著短于對(duì)照組,差異有統(tǒng)計(jì)學(xué)意義(雙側(cè)p及單側(cè)p均0.05)。4.術(shù)后當(dāng)天疼痛程度及肌注止痛藥用量比較:觀察組患者術(shù)后當(dāng)天疼痛程度以Ⅱ、Ⅳ度疼痛為主,Ⅱ度1例,Ⅳ度11例;對(duì)照組中,Ⅱ度4例,Ⅳ度11例。兩組患者疼痛程度相比差異無統(tǒng)計(jì)學(xué)意義(χ2=1.485,p0.05)。術(shù)后肌注止痛藥用量相比差異均無統(tǒng)計(jì)學(xué)意義(t=1.667,p0.05)。5.術(shù)后出血程度:觀察組患者術(shù)后出血程度以Ⅰ、Ⅱ度出血為主,Ⅰ度3例,Ⅱ度9例;對(duì)照組中,Ⅰ度4例,Ⅱ度11例。兩組患者出血程度相比差異無統(tǒng)計(jì)學(xué)意義(χ2=0.010,p0.05)。6.術(shù)后尿潴留比較:觀察組患者術(shù)后有5例(42%)出現(xiàn)尿潴留,需導(dǎo)尿,7例(58%)無尿潴留發(fā)生;對(duì)照組患者中有6例(40%)尿潴留,9例(60%)無尿潴留發(fā)生。兩組患者疼痛程度相比差異無統(tǒng)計(jì)學(xué)意義(P0.05)。7.肛門功能比較:觀察組與對(duì)照組在肛門對(duì)氣體、液體、固體等控制功能方面,差異無統(tǒng)計(jì)學(xué)意義(t=-0.891,p0.05)。8.治愈率比較:觀察組全部患者創(chuàng)面均上皮化,反復(fù)腫痛流膿癥狀消失,治愈率100%,對(duì)照組有1例患者隨訪期間肛瘺癥狀反復(fù),治愈率96.3%。差異無統(tǒng)計(jì)學(xué)意義(χ2=0.831,p0.05)。9.復(fù)發(fā)率比較:觀察組患者隨訪期間未發(fā)現(xiàn)復(fù)發(fā)病例,對(duì)照組1例患者在術(shù)后6個(gè)月再出現(xiàn)流膿等癥狀,經(jīng)換藥等保守治療后治愈,差異無統(tǒng)計(jì)學(xué)意義(χ2=0.831,p0.05)。結(jié)論:1.觀察組患者手術(shù)時(shí)間長(zhǎng)于對(duì)照組,主要因?yàn)橛^察組相比于對(duì)照組,需設(shè)計(jì)游離并將皮片縫合固定于創(chuàng)面,且肛門部手術(shù)野較小,將皮片與創(chuàng)緣縫合緊貼創(chuàng)面,屬于較精細(xì)操作,術(shù)中耗時(shí)增加30min以內(nèi),所延長(zhǎng)的手術(shù)時(shí)間并不明顯增加手術(shù)風(fēng)險(xiǎn),屬于可接受的的差異。2.兩組患者在治愈率、復(fù)發(fā)率、住院時(shí)間等指標(biāo)比較上其差異無統(tǒng)計(jì)學(xué)意義,說明本術(shù)式并不顯著延長(zhǎng)患者住院時(shí)間,療效相當(dāng)于甚至優(yōu)于經(jīng)典的肛瘺切除術(shù)。3.本術(shù)式大大縮短了患者術(shù)后愈合時(shí)間,同時(shí)術(shù)后疼痛程度、出血程度、尿潴留發(fā)生情況以及肛門功能相比兩組無顯著差異,說明本術(shù)式具有患者術(shù)后愈合快,療效可靠,手術(shù)安全性好等突出的特點(diǎn)及優(yōu)勢(shì)。
[Abstract]:Objective: anal fistula is a common clinical disease, operation is the main method for the treatment of anal fistula, and the wound healing is slow after operation. Through observation and comparison of the clinical efficacy and safety of two kinds of surgical treatment of humid lower simple anal fistula by anal fistula resection combined with anal skin grafting and anal fistula resection, the treatment of anal fistula combined with anal skin for anal fistula surgery. It provides a practical basis for the treatment of anal flaccid and provides a safe and effective treatment for the low position simple anal fistula with humid fever. Methods: 27 patients with low level anorectal fistula with low level of heat and heat were selected. The patients were randomly assigned to the observation group and the control group by the random digital table method. The observation group was treated with anal flaccid resection. Anus skin transplantation, control group underwent anal fistula resection, observe two groups of operation time, time of hospitalization, healing time, cure rate, recurrence rate, postoperative pain degree, bleeding degree and urinary retention, compare the curative effect and safety of the two groups. Results: the 1. operation time comparison: the operation time of the observation group Between (62 + 18) min and the control group (38 + 11) min, the difference was statistically significant (t=4.34, P0.05).2. hospital time comparison: the time of hospitalization of the observation group was (6.8 + 1.2) d, the time of hospitalization of the control group was (5.6 + 2.6) d, and the two groups were in the same time, the difference was not statistically significant (P0.05).3. healing time was (14.) healing time was (14.) (the time of union of observation group was (14.). 4 + 3.2) d, the healing time of the control group was (38.7 + 13.6) d, and the healing time of the observation group was significantly shorter than that of the control group. The difference was statistically significant (bilateral P and unilateral P 0.05). The pain degree and the dosage of painkillers were compared on the same day after.4.: the pain degree of the observation group was mainly II, IV degree pain, II degree 1, and 11 cases in the control group. The degree of pain in the two groups was not statistically significant (x 2=1.485, P0.05). There was no significant difference in the amount of pain relief drugs after operation (t=1.667, P0.05).5. after operation (t=1.667, P0.05). The degree of postoperative bleeding in the observation group was mainly I, II degree bleeding, I degree 3, and 9 cases; in the control group, 4 cases, I degree, I degree, degree I degree, I degree, I degree, I degree, in the control group. There were 11 cases of second degree. There was no significant difference in the degree of bleeding between the two groups (x 2=0.010, P0.05).6. postoperative urinary retention: 5 cases (42%) had urinary retention in the observation group and 7 cases (58%) had no urinary retention; 6 cases (40%) had urinary retention in the control group and 9 cases (60%) had no urinary retention. The difference of pain degree in the two group was different. No statistically significant (P0.05).7. anal function comparison: the observation group and the control group in the control function of the anus to the gas, liquid, solid and other control functions, the difference was not statistically significant (t=-0.891, P0.05).8. cure rate comparison: all the patients in the observation group were all epithelialization, repeated swelling and pain purulent symptoms disappeared, the cure rate was 100%, 1 cases in the control group were followed up. There was no statistically significant difference in the cure rate of 96.3%. (x 2=0.831, P0.05).9. recurrence rate: no recurrent cases were found in the observation group during the follow-up period, and 1 patients in the control group were reappeared after 6 months of operation, and the difference was not statistically significant (x 2=0.831, P0.05). Conclusion: 1. observation. The operation time of the group was longer than that of the control group, mainly because the observation group compared with the control group, it was necessary to design free and suture the skin slices to the wound, and the operation field of the anus was small, and the skin slices were sutured close to the wound, which was more fine operation, the time of operation increased less than 30min, and the extended operation time did not significantly increase the operation risk, There was no significant difference in the rate of cure, recurrence rate, and time of hospitalization in the two groups of patients with acceptable difference, which indicated that the operation did not significantly prolong the patient's time of hospitalization. The curative effect was equal to that of the classic anus fistulectomy, even better than the classical anus fistulectomy (.3.), which greatly shortened the postoperative healing time of the patients and the postoperative pain course. There were no significant differences between the two groups in degree, bleeding degree, urinary retention and anal function, which showed that the surgical method has the characteristics and advantages of quick healing, reliable curative effect and good operation safety.

【學(xué)位授予單位】：廣州中醫(yī)藥大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R657.16

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