内括约肌切开术与皮瓣推移术治疗慢性肛裂的临床对比研究.docVIP

内括约肌切开术与皮瓣推移术治疗慢性肛裂的临床对比研究 常远，袁维堂，王贵宪，张志永，宋军民 (450002 郑州，郑州大学第一附属医院肛肠外科) [摘要] 目的 评价侧方内括约肌切开术与肛裂切除U型皮瓣推移术治疗慢性肛裂的效果。方法 回顾性分析2008年2月至2011年1月在我院治疗的67例慢性肛裂患者的临床资料,并比较两种手术方式在手术时间、肛裂愈合时间、术后并发症发生率的差别。结果 内括约肌切开组患者全部愈合，皮瓣推移组患者2例感染后推移皮瓣裂开经换药引流愈合，其余均一期愈合。两组手术时间分别为（29.14±3.255）min、（45.33±4.370）min；术后肛裂愈合时间分别为（19±2.744）d、（8.66±1.153）d。组间比较差别有显著性意义(P 0.001)。而两组患者感染及肛门失禁的例数无显著性差异。结论 肛裂切除U型皮瓣推移术可作为替代侧方内括约肌切开术治疗慢性肛裂的一种手术方法。 [关键词]：肛裂 Clinical comparison between lateral internal anal sphincterotomy with anal advancement flap for chronic anal fissure Chang Yuan,Yuan Weitang, Wang Guixian, Zhang Zhiyong,Song Junmin (Department of Anal-Colorectal Surgery, First Affiliated Hospital of Zhengzhou University, Zhengzhou，450002，China) [Abstract] Objective To evaluate and compare lateral internal anal sphincterotomy with anal advancement flap for chronic anal fissure. Methods The clinical data of 67 cases of chronic anal fissure from February 2008 to January 2011 were analyzed retrospectively. The differences in operation time and healing time were compared. Results All patients in the lateral internal anal sphincterotomy group healed after surgery. Two cases of the anal advancement flap group failing with primary healing, healed after dressing change and drainage while the rest cases were all successful. The operation time was (29.14±3.255）min、（45.33±4.370）min respectively. The healing time was （19±2.744）d、（8.66±1.153）d respectively. The difference between the two groups was significant(P 0.001).There was no significant difference in infection and fecal incontinence. Conclusions Anal advancement flap is an alternative to lateral sphincterotomy for chronic anal fissure. [Key Words] Anal fissure 侧方内括约肌切开术被广泛认为是治疗慢性肛裂的有效手术方法，肛裂切除皮瓣推移术作为治疗慢性肛裂的新手术方法，也引起许多临床医师的兴趣而被逐渐推广。而对于这两种手术方法效果的临床对比在国内鲜有报道。我们回顾性分析2008年2月至2011年1月67例慢性肛裂病人分别采用侧方内括约肌切开术与肛裂切除U型皮瓣成形术的治疗效果，现报道如下。 1 资料与方法 1.1 一般资料 本组病人67例，所有病人发病时间均大于2个月，有不同程度的排便后肛门疼痛及便血。体格检查可见哨兵痔及肥大肛乳头，部分肛裂创面可见内括约肌纤维外露。并排除非正中线位置的肛裂及结核、克罗恩病、溃疡性结肠炎等局部表现为肛管上皮溃疡的系统性疾病