本文選題：高分辨肛門直腸測(cè)壓 + 高位復(fù)雜性肛瘺��； 參考：《福建中醫(yī)藥大學(xué)》2017年碩士論文

【摘要】：目的:低位切開(kāi)高位掛線術(shù)式為治療高位復(fù)雜性肛瘺的主流術(shù)式,療效確切,但術(shù)后創(chuàng)面大,對(duì)肛門功能有不同程度的影響。我科通過(guò)改良傳統(tǒng)術(shù)式,采用低位切開(kāi)留皮橋高位掛線術(shù)式治療高位復(fù)雜性肛瘺,既取得良好的療效,又較好的保護(hù)了肛門功能,但缺乏相關(guān)客觀數(shù)據(jù)的支持。高分辨肛門直腸測(cè)壓,分辨率高、數(shù)據(jù)精確,可用于肛門精細(xì)功能的評(píng)估。通過(guò)其對(duì)兩種不同術(shù)式術(shù)前、術(shù)后肛門功能的動(dòng)力學(xué)相關(guān)指標(biāo)的檢測(cè),評(píng)估手術(shù)對(duì)肛門功能的影響,驗(yàn)證低位切開(kāi)留皮橋高位掛線術(shù)式的優(yōu)越性。方法:選取符合納入標(biāo)準(zhǔn)的患者40例,隨機(jī)分成2組,治療組(20例)采用低位切開(kāi)留皮橋高位掛線的手術(shù)方式治療,對(duì)照組(20例)采用低位切開(kāi)高位掛線的手術(shù)方式治療。觀察兩組肛腸動(dòng)力學(xué)相關(guān)指標(biāo)、愈合時(shí)間、疼痛、肛門功能(漏氣、漏液、漏便情況)及復(fù)發(fā)率情況,并對(duì)指標(biāo)進(jìn)行統(tǒng)計(jì)學(xué)分析。結(jié)果:(1)治療組和對(duì)照組經(jīng)過(guò)治療后總體療效無(wú)顯著性差異(P0.05)。(2)兩組術(shù)后第1天疼痛評(píng)分無(wú)統(tǒng)計(jì)學(xué)差異,治療組術(shù)后第7天、第14天、第21天疼痛低于對(duì)照組。(3)兩組術(shù)后3個(gè)月、術(shù)后半年肛門功能(漏氣、漏液、漏便情況)在統(tǒng)計(jì)學(xué)上有顯著差異。(4)兩組直腸肛管收縮反射與直腸肛管抑制反射在術(shù)后3個(gè)月、術(shù)后半年無(wú)統(tǒng)計(jì)學(xué)差異。(5)兩組肛管靜息壓、肛管平均收縮壓、肛管最大收縮壓術(shù)后3個(gè)月較術(shù)前下降,治療組術(shù)后半年較術(shù)前無(wú)統(tǒng)計(jì)學(xué)差異,對(duì)比兩組在術(shù)后3個(gè)月、術(shù)后半年有統(tǒng)計(jì)學(xué)差異。(6)兩組感覺(jué)測(cè)試初始感覺(jué)容量、最大耐受容量術(shù)后3個(gè)月較術(shù)前下降,治療組術(shù)后半年較術(shù)前無(wú)統(tǒng)計(jì)學(xué)差異,對(duì)比兩組在術(shù)后3個(gè)月、術(shù)后半年有統(tǒng)計(jì)學(xué)(7)兩組肛管功能長(zhǎng)度術(shù)后3個(gè)月較術(shù)前縮短,治療組術(shù)后半年較術(shù)前無(wú)統(tǒng)計(jì)學(xué)差異,對(duì)比兩組在術(shù)后3個(gè)月、術(shù)后半年有統(tǒng)計(jì)學(xué)差異。(8)治療組術(shù)后愈合平均時(shí)間(47.80±6.092)天,對(duì)照組平均愈合時(shí)間(54.20±4.629)天,有統(tǒng)計(jì)學(xué)差異。結(jié)論:低切高掛術(shù)作為高位復(fù)雜性肛瘺的傳統(tǒng)主流術(shù)式,療效確切,但對(duì)肛門功能有不同程度的影響.低位切開(kāi)留皮橋高位掛線術(shù)是我科在傳統(tǒng)術(shù)式基礎(chǔ)上的創(chuàng)新術(shù)式,在保護(hù)肛門括約肌、肛門功能,減輕術(shù)后疼痛,促進(jìn)術(shù)后創(chuàng)面愈合等優(yōu)越性,最大程度上減輕患者痛苦,提高患者術(shù)后生活質(zhì)量。
[Abstract]:Objective: low incision and high end threading is the main method for treating high complex anal fistula. The curative effect is accurate, but the wound is large after operation, which has different influence on anal function. Our department improved the traditional operation and used low incision and skin bridge high position thread to treat high complex anal fistula, which not only achieved good curative effect, but also protected anal function well, but lacked the support of relevant objective data. High resolution anorectal manometry, high resolution, accurate data, can be used for the evaluation of anal fine function. The influence of operation on anus function was evaluated by detecting the dynamic indexes of anus function before and after two different operations, and the superiority of the high perpendicular ligature with low incision and skin bridge was verified. Methods: 40 patients who met the inclusion criteria were randomly divided into two groups. The treatment group (20 cases) was treated by the operation of low incision and left skin bridge, and the control group (20 cases) was treated by low incision and high thread. The related indexes of anorectal dynamics, healing time, pain, anal function (air leakage, leakage of fluid, leakage of stool) and recurrence rate were observed and analyzed statistically. Results: (1) there was no significant difference in the overall curative effect between the treatment group and the control group after treatment (P0.05). (2). There was no significant difference in pain score between the two groups on the first day after operation. The pain in the treatment group was lower than that in the control group on the 7th, 14th and 21st day after operation. (3) the pain in the two groups was lower than that in the control group at 3 months after operation. There were significant differences in anal function (air leakage, leakage of fluid, leakage of stool) between the two groups. (4) there was no statistical difference between the two groups in rectal anal reflex and rectoanal reflex at 3 months after operation and half a year after operation. (5) resting anal pressure was not significantly different between the two groups. The mean systolic pressure of anal canal and the maximum systolic pressure of anal canal decreased 3 months after operation, but there was no significant difference between the treatment group and the preoperative half year. (6) the initial sensory capacity and maximal tolerance volume of the two groups were decreased 3 months after operation, but there was no significant difference between the two groups in the half year after operation, and in the three months after operation, there was no statistical difference between the treatment group and the treatment group, and there was no significant difference between the two groups in 3 months after operation. The length of anal canal function in two groups was shorter than that before operation in 3 months after operation, but there was no significant difference in treatment group in half a year after operation, and there was no significant difference between the two groups in 3 months after operation. (8) the average healing time was (47.80 鹵6.092) days in the treatment group and (54.20 鹵4.629) days in the control group. Conclusion: low shear and high hanging operation is the traditional main operative method of high complex anal fistula, the curative effect is accurate, but it has different influence on anal function. Low incision and left skin bridge is an innovative operation based on the traditional operation, which can protect anal sphincter and anal function, relieve postoperative pain, promote wound healing, and alleviate the pain of patients to the greatest extent. To improve the quality of life after operation.
【學(xué)位授予單位】：福建中醫(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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