【摘要】：目的:觀察內(nèi)口切閉術(shù)治療肛瘺時(shí)對(duì)內(nèi)口封閉的臨床療效。方法:病人總數(shù)30人,是2014年9月份-2017年3月份,在南京市中醫(yī)院手術(shù)治療肛瘺的病人,分組按自愿原則,共兩組,試驗(yàn)組(n=15)采用內(nèi)口切閉術(shù),對(duì)照組(n=15)采用直腸黏膜瓣推移術(shù)。比較兩組術(shù)后內(nèi)口封閉情況、封閉內(nèi)口手術(shù)時(shí)間、術(shù)后疼痛度、異物感等指標(biāo);觀察試驗(yàn)組術(shù)中吻合釘吻合度及術(shù)后鈦釘殘留(肉眼可見(jiàn))情況。結(jié)果根據(jù)評(píng)分記錄,經(jīng)統(tǒng)計(jì)學(xué)處理,分析評(píng)估其封閉內(nèi)口的療效、手術(shù)安全性等。結(jié)果:(1)通過(guò)統(tǒng)計(jì)學(xué)分析,兩組的一般資料(包括性別和年齡)P值大于0.05,說(shuō)明試驗(yàn)組與對(duì)照組具有可比性。(2)觀察術(shù)后第3天、7天、14天,兩組內(nèi)口封閉情況及內(nèi)口感染差異均無(wú)統(tǒng)計(jì)學(xué)意義(P0.05),說(shuō)明術(shù)后3天、7天、14天,試驗(yàn)組和對(duì)照組內(nèi)口閉合情況無(wú)明顯差異。試驗(yàn)組封閉內(nèi)口的手術(shù)時(shí)間范圍5-9分鐘,對(duì)照組封閉內(nèi)口的手術(shù)時(shí)間范圍5-12分鐘,兩組封閉內(nèi)口的手術(shù)時(shí)間比較,差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。術(shù)后3天、7天、30天兩組的疼痛評(píng)分比較,患者異物感評(píng)分比較,差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。由此可見(jiàn)內(nèi)口切閉術(shù)與直腸黏膜瓣推移術(shù)相比較,內(nèi)口封閉的效果相似,且術(shù)后造成的疼痛度與異物感上也無(wú)明顯差異。(3)試驗(yàn)組在手術(shù)中切閉后,切閉后形成的吻合處釘子全部成型,其中只有有1例切閉處有活動(dòng)性出血,可能與吻合邊緣未能將切除的內(nèi)口全部吻合,邊緣出血有關(guān)。試驗(yàn)組手術(shù)后7天、30天,發(fā)現(xiàn)5例患者在術(shù)后7天內(nèi)肉眼觀察未發(fā)現(xiàn)鈦釘,30天后15例患者吻合處鈦釘在肉眼觀察下均未發(fā)現(xiàn),指診無(wú)明顯鈦釘殘留感。說(shuō)明內(nèi)口切閉術(shù)安全并且不會(huì)有明顯的鈦釘殘留的問(wèn)題。結(jié)論:內(nèi)口切閉術(shù)在封閉內(nèi)口方面與直腸黏膜推移術(shù)療效相似,在疼痛、異物感,封閉內(nèi)口手術(shù)時(shí)間部分有一定長(zhǎng)處,操作安全。由此可見(jiàn)內(nèi)口切閉術(shù)作為新術(shù)式微創(chuàng)安全療效明確,值得進(jìn)一步研究推廣。
[Abstract]:Objective: to observe the clinical effect of internal mouth closure in the treatment of anal fistula. Methods: from September 2014 to March 2017, 30 patients were treated with anal fistula in Nanjing traditional Chinese Medicine Hospital. The patients were divided into two groups according to voluntary principle. The control group (nong15) was treated with rectal mucosal flap. The intraoperative closure time, postoperative pain, and foreign body sensation were compared between the two groups, and the anastomosis degree of intraoperative anastomosis and the residual titanium nail (visible to naked eyes) were observed in the experimental group. Results according to the score record, the curative effect and the safety of the operation were evaluated by statistical analysis. Results: (1) by statistical analysis, the general data (including gender and age) of the two groups were more than 0.05, indicating that the experimental group was comparable with the control group. (2) the 3rd, 7th and 14th days after operation were observed. There was no significant difference in internal mouth closure and infection between the two groups (P0.05), which indicated that there was no significant difference between the experimental group and the control group in the closure of the internal mouth 3 days, 7 days and 14 days after operation. The operation time range of the treatment group was 5-9 minutes, and that of the control group was 5-12 minutes. There was no significant difference between the two groups (P0.05). There was no significant difference in pain score and foreign body sensation score between the two groups on the 3rd, 7th and 30th day after operation (P0.05). It can be seen that the effect of internal closure is similar to that of rectal mucosal flap, and there is no significant difference in the degree of pain and foreign body sensation after operation. (3) after operation, there is no significant difference between the experimental group and the control group. All the nails formed after closure were formed, among which only one case had active bleeding, which may be related to the failure of the anastomotic margin to completely anastomose the excision of the inner orifice, and to the bleeding in the margin. In the test group, no titanium nail was found in 5 patients within 7 days after operation, and no titanium nail was found in the anastomosis of 15 patients after 30 days. This indicates that internal closure is safe and there is no significant residual titanium nail problem. Conclusion: the curative effect of internal incision closure is similar to that of rectal mucosal process, and it has some advantages in pain, foreign body sensation and the time of closing internal mouth, and it is safe to operate. This shows that internal incision closure as a new operation minimally invasive safety effect is clear, worthy of further study and promotion.
【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】：2017
【分類(lèi)號(hào)】：R657.1

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