经括约肌间瘘管结扎术和肛瘘切开挂线术治疗复杂性肛瘘的效果对比

doi:10.3969/j.issn.1006-6233.2026.02.017

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摘要 目的: 探讨经括约肌间瘘管结扎术(LIFT)和肛瘘切开挂线术治疗复杂性肛瘘的疗效及对肛门功能、术后复发的影响。方法: 回顾性选取安庆市立医院收治的复杂性肛瘘患者90例为研究对象,入院时间均为2021年1月至2024年8月。按照手术方法将其分为切开挂线组(41例,行肛瘘切开挂线术)和LIFT组(49例,行LIFT术)。治疗后,观察两组临床疗效,围术期指标、术后3个月肛门功能,记录两组并发症及复发情况。结果: LIFT组与切开挂线组治疗总有效率均为100.00%,两组差异不具有统计学意义(P>0.05);LIFT组创面愈合时间、住院时间均短于对照组,术中出血量少于对照组,术后7d 视觉模拟评分法(VAS)评分低于对照组,创面小于对照组(P<0.05);术后3个月,两组wexner失禁评分、肛管静息压、肛管最大收缩压均较术前降低,且LIFT组wexner失禁评分手术前后差值大于切开挂线组,肛管静息压、肛管最大收缩压手术前后差值小于切开挂线组,差异均具有统计学意义(P<0.05);LIFT组总并发症发生率6.12%低于切开挂线组21.95%(P<0.05),术后6个月复发率0.00%低于切开挂线组9.76%(P<0.05)。结论: LIFT与肛瘘切开挂线术治疗复杂性肛瘘患者疗效相当,但LIFT在切口面积,术后疼痛与愈合以及并发症方面控制较好,对肛门功能影响也较小,术后6个月复发率更低。

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关键词 ：复杂性肛瘘, 经括约肌间瘘管结扎术, 切开挂线术, wexner失禁评分

Abstract：Objective: To explore the curative effect of ligation of intersphincteric fistula tract (LIFT) and incision-thread-drawing therapy for complex anal fistula and their influences on anal function and postoperative recurrence. Methods: A total of 90 patients with complex anal fistula admitted to the Anqing Municipal Hospital between January 2021 and August 2024 were retrospectively enrolled as the research subjects. According to the different surgical methods, they were divided into an incision-thread-drawing group (41 cases, incision-thread-drawing therapy) and a LIFT group (49 cases, LIFT). After treatment, clinical curative effect, perioperative indexes and anal function at 3 month after surgery in the two groups were observed, with the complications and recurrence recorded. Results: There was no significant difference in response rate of treatment between groups (all 100.00%, P>0.05). The wound healing time and length of hospital stay in LIFT group were shorter, intraoperative blood loss was less, scores of visual analogue scale (VAS) was lower, and the wound was smaller than those in incision-thread-drawing group at 7d after surgery (P<0.05). At 3 months after surgery, scores of wexner incontinence, anal canal rest pressure and anal maximal contraction pressure were decreased in both groups. Moreover, the difference value in wexner incontinence score before and after surgery in LIFT group was greater, while difference values in anal canal rest pressure and anal maximal contraction pressure before and after surgery were lower than those in incision-thread-drawing group, the differences were all statistically significant. (P<0.05). The incidence of complications in LIFT group was lower than that in incision-thread-drawing group (6.12% vs 21.95%, P<0.05). At 6 months after surgery, recurrence rate in LIFT group was lower than that in incision-thread-drawing group (0.00% vs 9.76%, P<0.05). Conclusion: The curative effect of LIFT and incision-thread-drawing therapy is similar in patients with complex anal fistula. However, LIFT is more advantageous in terms of controlling incision area, postoperative pain, healing and complications, which has fewer effects on anal function and lower recurrence rate at 6 months after surgery.

Key words： Complex anal fistula Intersphincteric fistula tract Incision-thread-drawing therapy Wexner incontinence score

基金资助:2022年安徽省卫生计生委科研计划项目,(编号:AHWJ2022b067)

通讯作者: 施林

引用本文:

熊思, 石柳亿, 贺磊, 邵帅, 施林. 经括约肌间瘘管结扎术和肛瘘切开挂线术治疗复杂性肛瘘的效果对比[J]. 河北医学, 2026, 32(2): 282-287.
XIONG Si, SHI Liuyi, HE Lei, et al. Comparative Study of the Efficacy of Ligation of Intersphincteric Fistula Tract Versus Incision-Thread-Drawing Therapy for Complex Anal Fistulae. HeBei Med, 2026, 32(2): 282-287.

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http://www.hbyxzzs.cn/CN/10.3969/j.issn.1006-6233.2026.02.017 或 http://www.hbyxzzs.cn/CN/Y2026/V32/I2/282

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