本文關(guān)鍵詞： 肛瘺 閉合內(nèi)口 潛行刨削 切閉器　出處：《南京中醫(yī)藥大學(xué)》2016年碩士論文　論文類(lèi)型：學(xué)位論文

【摘要】：目的：對(duì)內(nèi)口切閉聯(lián)合瘺道潛行刨削術(shù)治療肛瘺的臨床療效性及安全性進(jìn)行評(píng)價(jià)。方法:選取2015年1月-2016年1月由南京市中醫(yī)院王業(yè)皇教授進(jìn)行手術(shù)治療的70例肛瘺患者,依自愿原則分兩組,試驗(yàn)組(n=32)采用內(nèi)口切閉聯(lián)合瘺道潛行刨削術(shù)治療,對(duì)照組(n=38)采用傳統(tǒng)切開(kāi)術(shù)或切開(kāi)掛線(xiàn)術(shù)治療。比較兩組疼痛程度、肛門(mén)括約肌功能及不良事件發(fā)生率,并隨訪(fǎng)3個(gè)月,記錄愈合時(shí)間和治療結(jié)果。觀察結(jié)果根據(jù)評(píng)分標(biāo)準(zhǔn)均作量化記錄,經(jīng)統(tǒng)計(jì)學(xué)處理,分析其療效性、微創(chuàng)性、安全性等方面的差異。結(jié)果：(1)試驗(yàn)組和對(duì)照組的總有效率分別為96.87%和92.10%,差異無(wú)統(tǒng)計(jì)學(xué)意義(P--0.668)。(2)兩組的術(shù)后VAS疼痛評(píng)分比較,術(shù)后第1天、第3天差異均無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)；術(shù)后第7天、第15天、第30天、第50天差異有統(tǒng)計(jì)學(xué)意義(P0.05)。(3)兩組的術(shù)前Wexner評(píng)分比較,無(wú)統(tǒng)計(jì)學(xué)差異(P0.05),具有可比性；兩組術(shù)后第1月、第2月、第3月的Wexner評(píng)分比較,有統(tǒng)計(jì)學(xué)差異(P0.05)；試驗(yàn)組的Wexner評(píng)分在術(shù)前和術(shù)后第3月比較,無(wú)統(tǒng)計(jì)學(xué)差異(P0.05),對(duì)照組反之。(4)兩組的術(shù)前肛門(mén)功能指診評(píng)分比較,無(wú)統(tǒng)計(jì)學(xué)差異(P0.05),具有可比性；兩組術(shù)后第1月、第2月的肛門(mén)功能指診評(píng)分比較,無(wú)統(tǒng)計(jì)學(xué)差異(P0.05),兩組術(shù)后第3月的肛門(mén)功能指診評(píng)分比較,有統(tǒng)計(jì)學(xué)差異(P0.05)；試驗(yàn)組的肛門(mén)功能指診評(píng)分在術(shù)前和術(shù)后第3月比較,無(wú)統(tǒng)計(jì)學(xué)差異(P0.05),對(duì)照組反之。(5)兩組在創(chuàng)面愈合時(shí)間上的差異有統(tǒng)計(jì)學(xué)意義(P0.05)。(6)兩組的安全性結(jié)果比較,差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。(7)痊愈后隨訪(fǎng)3個(gè)月,試驗(yàn)組復(fù)發(fā)0例,對(duì)照組復(fù)發(fā)1例(2.63%),差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。結(jié)論：采用內(nèi)口切閉聯(lián)合瘺道潛行刨削術(shù)治療肛瘺是一種安全的微創(chuàng)術(shù)式,其療效確切,可減輕痛苦、減小肛門(mén)損傷、縮短愈合時(shí)間。
[Abstract]:Objective: to evaluate the clinical efficacy and safety of internal incision combined with closed fistula in the treatment of anal fistula. Methods: from January 2015 to January 2016, 70 cases of anal fistula treated by Professor Wang Yehuang, Nanjing traditional Chinese Medicine Hospital, were selected. According to the voluntary principle, the experimental group was divided into two groups. The experimental group was treated with internal incision and closed fistula, and the control group was treated with traditional incision or incision and thread. The degree of pain, anal sphincter function and the incidence of adverse events were compared between the two groups. The healing time and treatment results were recorded for 3 months. The results were quantitatively recorded according to the scoring criteria, and the curative effect and minimally invasive effect were analyzed by statistical analysis. Results the total effective rates of the two groups were 96.87% and 92.10, respectively. There was no significant difference in postoperative VAS pain score between the two groups. There was no significant difference in preoperative Wexner scores between the two groups on the 3rd day (P 0.05); on the 7th, 15th, 30th and 50th day after operation, there was no significant difference in preoperative Wexner scores between the two groups (P 0.05); on January, February, there was no significant difference between the two groups. In March, there was a significant difference in Wexner scores between the two groups (P 0.05). There was no significant difference in the Wexner scores between the two groups before and after operation (P 0.05), whereas in the control group (P 0. 05), there was no significant difference between the two groups before and after operation (P 0. 05). There was no statistical difference between the two groups (P 0.05), there was no statistical difference between the two groups in anal functional finger-diagnosis scores on January and February, and there was no significant difference between the two groups in anal function index scores on March. There was no significant difference in anal function index score between the two groups before and after operation on March, but there was no significant difference in the wound healing time between the two groups (P 0.05, P 0.05, P 0.05, P 0.05, P 0.05, P 0.05, P 0.05, P 0.05, P 0.05, P 0.05, P 0.05, P 0.05, P 0.05, P 0.05, P 0.05, P 0.05, P 0.05). There was no significant difference between the two groups in 3 months after recovery. There were 0 cases of recurrence in the trial group and 1 case in the control group. The difference was not statistically significant (P 0.05). Conclusion: it is a safe and minimally invasive procedure to treat anal fistula with closed internal orostomy combined with latent planning of fistula. Its curative effect is accurate, can alleviate pain, reduce anal injury, shorten healing time.
【學(xué)位授予單位】：南京中醫(yī)藥大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2016
【分類(lèi)號(hào)】：R266

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