本文選題：改良切開掛線 + 保留括約肌�。� 參考：《河北醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的:肛瘺是指由于病理原因在肛管或直腸形成的與肛門周圍皮膚相通的一種異常管道。隨著人們生活方式的改變,高位肛瘺在肛瘺中的發(fā)病率越來(lái)越高,而手術(shù)是治療高位肛瘺最有效的方法。肛瘺切開掛線術(shù)是治療高位肛瘺最常用的術(shù)式,雖然傳統(tǒng)術(shù)式通過(guò)掛線療法慢性切割肌肉,但是對(duì)肛門功能還是有一定的影響。現(xiàn)在如何在治愈疾病的情況下,最大限度的保留肛門括約肌的功能是我們研究的方向。通過(guò)研究改良肛瘺切開掛線術(shù)與傳統(tǒng)切開掛線術(shù)治療高位肛瘺的患者在術(shù)后治愈率(術(shù)后4周)、遠(yuǎn)期復(fù)發(fā)率(術(shù)后6個(gè)月)、術(shù)后疼痛(術(shù)后24小時(shí))、住院時(shí)間及手術(shù)后肛門功能評(píng)分(術(shù)后4周)進(jìn)行對(duì)照分析,來(lái)觀察和評(píng)價(jià)應(yīng)用改良肛瘺切開掛線術(shù)治療高位肛瘺的臨床療效。方法:將80例符合納入標(biāo)準(zhǔn)的高位肛瘺患者按隨機(jī)方法分成治療組和對(duì)照組,每組40例。經(jīng)統(tǒng)計(jì)學(xué)檢驗(yàn),兩組在年齡、性別、肛瘺類型方面,P0.05,差異無(wú)統(tǒng)計(jì)學(xué)意義,具有可比性(見(jiàn)Table1、Table2、Table3)。治療組采用改良肛瘺切開掛線術(shù),對(duì)照組采用傳統(tǒng)肛瘺切開掛線術(shù),觀察分析兩組的治療效果,主要從術(shù)后治愈率(術(shù)后4周)、遠(yuǎn)期復(fù)發(fā)率(術(shù)后6個(gè)月)、術(shù)后疼痛、住院時(shí)間及手術(shù)后肛門功能評(píng)分(術(shù)后4周)進(jìn)行觀察評(píng)估比較。結(jié)果:1兩組總體治愈率(術(shù)后4周)及遠(yuǎn)期復(fù)發(fā)率(術(shù)后6個(gè)月)的比較。(見(jiàn)Table4、Table5)治療組術(shù)后4周達(dá)到痊愈標(biāo)準(zhǔn)40例,好轉(zhuǎn)0例,無(wú)效0例,臨床總治愈率為100%;對(duì)照組術(shù)后4周達(dá)到痊愈標(biāo)準(zhǔn)27例,好轉(zhuǎn)11例,無(wú)效2例,臨床總治愈率為95%;治療組術(shù)后6個(gè)月回訪,痊愈39人,1人復(fù)發(fā),復(fù)發(fā)率為2.5%;對(duì)照組術(shù)后6個(gè)月回訪,痊愈37人,3人復(fù)發(fā),復(fù)發(fā)率為7.5%。兩組在總體治愈率(術(shù)后4周)及遠(yuǎn)期復(fù)發(fā)率(術(shù)后6個(gè)月)經(jīng)Fisher精確檢驗(yàn),P0.05,在治愈率與遠(yuǎn)期復(fù)發(fā)率無(wú)統(tǒng)計(jì)學(xué)差異。2兩組術(shù)后疼痛情況比較(Table6)通過(guò)治療組與對(duì)照組術(shù)后24小時(shí)疼痛評(píng)分對(duì)比,經(jīng)秩和檢驗(yàn),P0.05,差異有統(tǒng)計(jì)學(xué)意義。術(shù)后治療組在術(shù)后24小時(shí)疼痛程度明顯低于對(duì)照組。3兩組住院時(shí)間比較(Table7)兩組術(shù)后住院時(shí)間比較,經(jīng)t檢驗(yàn)(兩組數(shù)據(jù)符合正態(tài)分布和方差齊性),差異有統(tǒng)計(jì)學(xué)意義(P0.05),治療組住院時(shí)間明顯少于對(duì)照組。4兩組在手術(shù)4周后肛門括約肌功能、肛門指診情況評(píng)分的比較(Table8)通過(guò)兩組在手術(shù)4周后肛門括約肌功能、肛門指診情況評(píng)分的比較,經(jīng)秩和檢驗(yàn),P0.05,差異有統(tǒng)計(jì)學(xué)意義;治療組在術(shù)后4周肛門自制功能明顯優(yōu)于對(duì)照組。結(jié)論:1改良肛瘺切開掛線術(shù)與傳統(tǒng)肛瘺切開掛線術(shù)均有滿意的臨床療效。2改良肛瘺切開掛線術(shù)較傳統(tǒng)肛瘺切開掛線術(shù)有效的減輕了術(shù)后疼痛。3改良肛瘺切開掛線術(shù)較傳統(tǒng)肛瘺切開掛線術(shù)明顯的縮短住院時(shí)間。4改良肛瘺切開掛線術(shù)較傳統(tǒng)肛瘺切開掛線術(shù)能更好地保護(hù)肛門括約肌功能。
[Abstract]:Objective: anal fistula refers to an abnormal tube formed by the anal canal or rectum because of pathological causes. As the lifestyle changes, the incidence of high anal fistula in the anal fistula is getting higher and higher, and surgery is the most effective method for the treatment of high anal fistula. Anal fistula incision and hanging is the most common treatment for high anal fistula. Although the traditional surgical method has a certain influence on the function of the anus, it has a certain influence on the function of the anus. It is our research direction how to preserve the function of the anal sphincter to the maximum extent under the condition of curing the disease. The postoperative cure rate (4 weeks after the operation), the long-term recurrence rate (6 months after operation), postoperative pain (24 hours after operation), the time of hospitalization and the anal function score after operation (4 weeks after the operation) were analyzed to observe and evaluate the clinical efficacy of the modified anal fistula incision and thread operation in the treatment of high anal fistula. Methods: 80 cases were conformed to the high standard. The patients with anus fistula were randomly divided into treatment group and control group, with 40 cases in each group. The two groups had no statistical difference in age, sex and type of anal fistula by statistical test. The difference was not statistically significant (see Table1, Table2, Table3). The treatment group was treated with improved anal fistula cutting and hanging line operation, and the control group was divided into traditional anal fistula incision and hanging line, and the observation score was observed. Analysis of the curative effect of two groups, mainly from the postoperative cure rate (4 weeks after operation), the long-term recurrence rate (6 months after operation), postoperative pain, hospital time and postoperative anal function score (4 weeks after the operation) compared. Results: the total cure rate of 1 two groups (4 weeks after operation) and the long-term recurrence rate (6 months after operation). (see Table4, Table5) treatment group operation After 4 weeks, 40 cases were cured, 0 cases were improved, 0 cases were invalid, the total clinical cure rate was 100%, 27 cases were recovered in the control group 4 weeks after operation, 11 cases were improved, 2 cases were invalid, and the total clinical cure rate was 95%. The treatment group recovered 6 months after the operation, recovered 39, recurrent, recurrence rate. The rate was 7.5%. two in the total cure rate (4 weeks after operation) and the long-term recurrence rate (6 months after operation) by Fisher accurate test, P0.05, there was no statistical difference between the cure rate and the long-term recurrence rate (Table6) in group.2 two (Table6), compared with the 24 hour pain score of the treatment group and the control group, through the rank sum test, the difference was statistically significant. After 24 hours after operation, the pain degree of the treatment group was significantly lower than that of the control group.3 two groups (Table7), the time of hospitalization was compared between the two groups, and the difference was statistically significant (P0.05) by t test (P0.05), and the residence time of the treatment group was significantly less than that of the control group two groups after the operation 4 weeks after the operation. Compared with the anal sphincter function and anus diagnosis score after 4 weeks of operation, the comparison of the anal sphincter function and the anus diagnosis score of the two groups was statistically significant in the two groups. The treatment group was significantly better than the control group at 4 weeks after the operation. Conclusion: 1 improved anal fistula and traditional anal fistula in 1 anal fistula. .2 improved anal fistula incision and hanging line operation compared with traditional anal fistula incision and hanging line operation effectively alleviated postoperative pain.3 improved anal fistula incision and hanging thread operation compared with traditional anal fistula incision and hanging line operation, the improved anus fistula was significantly shorter in hospital time.4 improved anal fistula incision and hanging line surgery better than traditional anal fistula incision and hanging line operation can better protect the anus The function of the sphincter.

【學(xué)位授予單位】：河北醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R657.16

【參考文獻(xiàn)】

相關(guān)期刊論文 前10條

1 沈彬慧;趙學(xué)理;郭修田;;復(fù)雜性肛瘺保留括約肌手術(shù)的研究[J];長(zhǎng)春中醫(yī)藥大學(xué)學(xué)報(bào);2016年06期

2 鄧大鵬;鄧正明;鄭玉金;;鄧正明主任高掛低切曠置引流術(shù)治療高位復(fù)雜性肛瘺的臨床研究[J];中外醫(yī)療;2016年34期

3 劉鳴偉;;一次性肛瘺切開術(shù)與肛瘺切開掛線術(shù)治療低位肛瘺療效臨床研究[J];中國(guó)實(shí)用醫(yī)藥;2016年28期

4 涂強(qiáng);;肛瘺切除術(shù)聯(lián)合掛線法對(duì)高位肛瘺的治療效果觀察[J];基層醫(yī)學(xué)論壇;2016年07期

5 宋穎剛;高昆;;皮瓣推移與切開掛線術(shù)對(duì)復(fù)雜肛瘺患者術(shù)后肛門功能的影響研究[J];中國(guó)醫(yī)藥指南;2016年06期

6 董青軍;梁宏濤;姚一博;潘一濱;張強(qiáng);殷立新;王琛;郭修田;曹永清;陸金根;;國(guó)內(nèi)拖線術(shù)治療肛瘺的臨床療效性及安全性的系統(tǒng)評(píng)價(jià)[J];世界中醫(yī)藥;2015年04期

7 陳偉偉;谷云飛;;黏膜下移保留括約肌術(shù)治療肛瘺的臨床療效觀察[J];結(jié)直腸肛門外科;2015年02期

8 林海鷗;;括約肌間瘺管結(jié)扎術(shù)與切開掛線術(shù)治療復(fù)雜性肛瘺的臨床療效比較[J];吉林醫(yī)學(xué);2015年08期

9 金玉明;洪桂榮;孫望星;;73例肛瘺患者的腔內(nèi)超聲影像分析[J];中國(guó)醫(yī)藥指南;2015年03期

10 于錦利;段宏巖;;括約肌間瘺結(jié)扎術(shù)治療肛瘺23例臨床觀察[J];中外醫(yī)學(xué)研究;2014年36期

相關(guān)博士學(xué)位論文 前1條

1 鄭麗華;安阿sピ擻玫臀磺鋅呶豢踔梅ㄖ瘟聘呶桓仞木樽芙峒傲俅慚芯縖D];中國(guó)中醫(yī)科學(xué)院;2013年

，

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