摘要目的 探讨两种不同手术方法治疗马蹄形肛瘘的临床效果.方法 选取2016年1月至2018年6月德州市人民医院肛肠外科收治的98例马蹄形肛瘘患者,按照不同手术类型分为马蹄形A组与马蹄形B组,每组49例.马蹄形A组男26例,女23例,年龄(45. 23 ± 2. 67)岁,年龄范围为24~68岁.马蹄形B组男27例,女22例,年龄(46. 19 ± 2. 34)岁,年龄范围为22~66岁.马蹄形A组对肛门后正中内口进行切开处理,在外口部位或者是两侧的肛管末端作一呈现出放射状的切口,将纤维组织切除之后,保证其贯通肛缘的两侧切口,随后使用刮匙.马蹄形B组则是在探针探出之后使用挂线,并使用刮匙.比较两组不同手术方法治疗马蹄形肛瘘的临床治疗效果、创面愈合时间、术后疼痛评分、肛门括约肌评分及治疗满意率.结果 马蹄形A组患者的有效率为89. 8% (44/49),马蹄形B组患者的有效率为73. 5% (36/49).马蹄形A组有效率高于马蹄形B组,差异有统计学意义(P <0. 05).马蹄形 A 组患者的创面愈合时间[(6. 54 ± 0. 89) d]较马蹄形 B 组[(7. 89 ± 0. 92)d]短,术后疼痛评分[(2. 87 ± 0. 43)分]与肛门括约肌评分[(5. 67 ± 0. 67)分]较马蹄形B组[(3. 91 ± 0. 51)分、(7. 89 ± 0. 71)分]低,差异有统计学意义(P<0. 05).马蹄形A组患者的治疗满意率为89. 8% (44/49),马蹄形B组患者的治疗满意率为71. 4% (35/49),马蹄形A组患者的治疗满意率高于马蹄形B组,差异有统计学意义(P<0. 05).结论 放射状切开挂线对口引流术治疗马蹄形肛瘘能够获得更好的临床治疗效果,缩短创面愈合时间,预后更好,治疗满意度较高.

abstractsObjective To investigate the clinical effects of two different surgical methods for the treatment of horseshoe-shaped anal fistula. Methods A retrospective study was performed on 98 cases of patients with horseshoe-shaped anal fistula who were admitted from January 2016 to June 2018. According to different types of surgery, the patients were divided into the horseshoe-shaped A group and horseshoe-shaped B group,with 49 cases in each group. There were 26 male and 23 female in the horseshoe-shaped A group,aged (45. 23 ± 2. 67) years old,ranged from 24 to 68. There were 27 male and 22 female in the hor-seshoe-shaped A group,aged (46. 19 ± 2. 34) years old, ranged from 22 to 66. In the horseshoe-shaped group A,the posterior midline of the anus was cut open. A radial incision was made at the external orifice or at the ends of the anal tubes on both sides. After the removal of the fibrous tissue,the incisions on both sides of the anus were ensured to penetrate the anal margin. In the horseshoe-B group,a wire was used after the probe was out and a curette was used. The clinical efficacy, wound healing time, postoperative pain score,anal sphincter score and treatment satisfaction rate of horseshoe anal fistula were compared between the two groups using different surgical methods. Results The total effective rate was 89. 8% (44/49) in the horseshoe-shaped A group and 73. 5% (36/49) in the horseshoe-shaped group B. The total effective rate was higher in the horseshoe-shaped group A than in that in the horseshoe-shaped group B,and the difference was statistically significant (P<0. 05). The wound healing time [(6. 54 ± 0. 89) days] in the horseshoe group A was shorter than that in the horseshoe group B[(7. 89 ± 0. 92) days],and the postoper-ative pain score(2. 87 ± 0. 43) and anal sphincter score(5. 67 ± 0. 67) were lower than that in the horse-shoe group B (3. 91 ± 0. 51) and (7. 89 ± 0. 71),(P<0. 05). The treatment satisfaction rate of the horse-shoe A group was 89. 8% (44/49) and that of the horseshoe B group was 71. 4% (35/49). The treatment satisfaction rate of the horseshoe A group was higher than that of the horseshoe B group (P<0. 05). Con-clusion Radial incision and line-to-mouth drainage for horseshoe-shaped anal fistula can achieve better clinical efficacy,shorten wound healing time,with better prognosis and higher treatment satisfaction.