摘要目的 通过前瞻性随机对照研究,评价改良括约肌间瘘管结扎术治疗复杂性肛瘘的临床疗效.方法 将41例复杂性肛瘘患者随机分为观察组20例,对照组21例.观察组采用改良括约肌间瘘管结扎术,对照组采用肛瘘切开挂线术.第一随访终点指标是治愈率及术后肛门括约肌功能.第二随访终点指标是术后第3天和第7天肛门疼痛、住院时间以及复发后二次治疗方式.计量资料采用独立样本t检验或配对样本t检验,计数资料采用Fisher确切概率法,P＜0.05为差异有统计学意义.结果 观察组20例患者完成21例改良括约肌间瘘管结扎术(1例患者2根瘘管均行该术式),对照组完成21例均行肛瘘切开挂线术.观察组治愈率90％,对照组治愈率95％,差异无统计学意义(P=1.000).观察组随访终点1例患者存在漏气现象;对照组5例漏气,2例漏气伴漏稀便,两组Wexner评分差异有统计学意义(t=-2.200,p=0.037).观察组住院时间、术后第3天和第7天疼痛评分均优于对照组,差异有统计学意义(t=-7.266,P=0.000;t=-3.724,P=0.001;t=-7.921,P=0.000).结论 改良括约肌间瘘管结扎术不仅经济、安全、痛苦小,而且恢复快、治愈率高,且肛门括约肌功能保护好.

abstractsObjective To evaluate ligation of the intersphincteric fistula tract plus core-out fistulectomy for complex cryptoglandular anal fistulas.Methods Forty-one patients were divided into ligation and control group randomly.In ligation group (20 cases),patients underwent ligation of the intersphincteric fistula tract plus core-out fistulectomy procedure.While in control group (21 cases) fistulotomy on low sphincter with cutting-seton on high sphincter procedure was performed.The primary end points of the study were healing rate and continence by using the Wexner score.Secondary end points were postoperative pain in the third and seventh day with the use of the visual analog scale,length of hospital stay and followed measures for a recurrent fistula.Comparison of measurement data using independent samples t-test or paired samples t-test,compared with the count data using Fisher's exact test.Results There was no statistical difference in the healing rate between ligation group (90％) and control group (95％) (P ＞0.05).Postoperatively,one case in ligation group reported incontinence for gas,compared to 7 cases in control group,among these 7 cases 2 cases also had incontinence for watery stool.Statistical differences were found between two groups in Wexner scores,visual analog scale scores and length of hospital stay (P ＜0.05).Conclusion Ligation of the intersphincteric fistula tract plus core-out fistulectomy is an economical,safe,little painful,recovery enhanced and minimally invasive technique to treat complex anal fistulas.