定向挂线在高位肛瘘治疗中的临床效果_临床医学论文.docVIP

定向挂线在高位肛瘘治疗中的临床效果_临床医学论文 定向挂线在高位肛瘘治疗中的临床效果_临床医学论文 ［摘要］ 目的 治疗高位肛瘘时为避免使用传统挂线产生较严重的后遗症，提出有效解决办法。方法 使挂线按照手术者设定的方向缓慢切割、引流，即通过改变肛管与瘘管两侧橡皮筋的压力面积来产生压强差，导致不同的切割速度和距离以达到定向切割目的；并将效果与传统挂线做比较。结果 使用定向挂线治疗的患者未出现肛管畸形、肛门漏气漏液及大便失禁等后遗症；通过肛管测压检验其影响，显示诸项指标无显著改变；对比效果优于传统挂线，差异有显著性（0.05）。结论 定向挂线能有效地避免传统挂线导致的后遗症，并能较好地完成对挂线的要求。 ［关键词］ 高位肛瘘；定向挂线；传统挂线；压强差；后遗症 Clinical effect of orientation seton in curing high anal fistula ［Abstract］ Objective To find an efficient solution in case to avoid serious sequelae caused by traditional ligation when high anal fistula was treated.Methods Let the thread to incisione muscle slowly along the direction which operator designed.In order to obtain the purpose of directional incision,the different incisional velocity and distance should be gained by means of changing elastic stress arca to cause pressure difference between the sides of anal canal and fistula.Finally its effect was compared with traditional ligation’s.Results No sequelae such as anal canal deformity,anus air and juice leakage were appeared by using orientation seton.The anal canal measure pressure showed that all indexes affected by it weren’t distinctly changed.The contrastive outcome showed that it was better than traditional ligation.There was a significant difference between the two groups （0.05）.Conclusion Using orientation seton could efficiently avoid the sequelae caused by traditional ligation,and perfectly achieve the demand for ligation. ［Key words］ high and fistula;orientation seton;traditional ligation;pressure difference;sequela 治疗高位肛瘘通常采用挂线法处理主瘘管［1］；因捆扎肌束较多，传统挂线方式常会破坏肛管形态的完整，引起肛门关闭不全、漏气漏液、肛门瘙痒等后遗症［2］。笔者通过实践谨慎提出“定向挂线”这一概念供广大学者参考。自2003年笔者在临床上使用以来，在防止挂线后遗症方面优于传统挂线。病例筛选与治疗效果依据1975年全国肛肠学术会议制订的统一肛瘘诊断及疗效标准确定。现将结果报告如下。 1 资料与方法 1.1 一般资料 选择2002年1月～2004年10月，笔者对高位肛瘘行肛门外瘘管切除缝合与肛门外瘘管旷置效果对比的部分资料。因发现肛内主管挂线导致了较严重的肛门畸形等后遗症，遂改为定向挂线。前、后位以截石位时，主管道内口与3、9点连线的位置关系确定。定向挂线组30例；男27例、女3例，年龄20～60（平均41.8±11.3）岁；高位单纯肛瘘18例，高位复杂肛瘘12例；前位4例，后位26例；瘘管长度7～25 cm，外口距肛缘5～15 cm；既往有肛周疾病手术史者13例。传统挂线组30例；男25例，女5例，年龄18～