内口切开、瘘管主道内端挂线术并中药内服、熏洗治疗高位肛瘘的临床观察
|
摘要
目的：观察内口切开、瘘管主道内端挂线术并中药内服、熏洗治疗高位肛瘘的临床疗效,为临床治疗高位肛瘘提出一种综合的治疗方法。方法：将符合纳入标准的30例高位肛瘘的患者随机分为两组,治疗组采用内口切开、瘘管主道内端挂线术并中药内服、熏洗治疗,对照组采用传统肛瘘切开挂线术并中药熏洗治疗。详细观察患者疼痛、分泌物、愈合时间、愈合后伤口疤痕面积、肛门功能、疗效、复发情况以及客观化评定指标,如肛门直肠测压等。结果：两组病例在疗效、复发情况无明显差异,但在愈合时间、疼痛、分泌物、肛门外观情况、肛门功能等方面,治疗组明显优于对照组。结论：内口切开、瘘管主道内端挂线术并中药内服、熏洗治疗高位肛瘘具有痛苦轻、愈合时间短、肛门功能及外形保持良好的优点。
Objective:To observe the incision inside the mouth, fistula side hung up the main tract surgery and medicine oral,Fumigation treatment of high anal fistula of the clinical efficacy for the clinical treatment of high anal fistula propose a method of treatment. Methods:30 patients met the inclusion criteria in patients with high anal fistula were randomly divided into two groups. The treatment group were treated with incision within the mouth, fistula side hung up the main tract surgery and medicine oral,Fumigation treatment.The control group using the traditional incision line of anal fistula surgery.Detailed observation of patients with pain,secretions, healing time and scarring after healing the wound area, anal function, efficacy, recurrence and objective assessment of indicators, such as anorectal manometry and so on. Results:Two cases of curative effects, no significant difference in recurrence, but the healing time, pain, secretions, the appearance of the anus, anus functions, the treatment group was significantly better than the control group. Conclusion:I cut open the main fistula tract side hung oral surgery and medicine, Fumigation treatment of high anal fistula with a painful light, healing time is short, anal function and appearance to maintain good advantage.
Objective:To observe the incision inside the mouth, fistula side hung up the main tract surgery and medicine oral,Fumigation treatment of high anal fistula of the clinical efficacy for the clinical treatment of high anal fistula propose a method of treatment. Methods:30 patients met the inclusion criteria in patients with high anal fistula were randomly divided into two groups. The treatment group were treated with incision within the mouth, fistula side hung up the main tract surgery and medicine oral,Fumigation treatment.The control group using the traditional incision line of anal fistula surgery.Detailed observation of patients with pain,secretions, healing time and scarring after healing the wound area, anal function, efficacy, recurrence and objective assessment of indicators, such as anorectal manometry and so on. Results:Two cases of curative effects, no significant difference in recurrence, but the healing time, pain, secretions, the appearance of the anus, anus functions, the treatment group was significantly better than the control group. Conclusion:I cut open the main fistula tract side hung oral surgery and medicine, Fumigation treatment of high anal fistula with a painful light, healing time is short, anal function and appearance to maintain good advantage.
引文
[1]赵宝明.实用肛门直肠病治疗学[M].北京：人民军医出版社,2009：115.
[2]隋.巢元方.诸病源侯论.人民卫生出版社,1984.
[3]陈红风.中医外科学.中国中医药出版社,2005,476.
[4]明.陈文治.疡科选粹.上海：上海新中华书社,扫叶山房石印本,中华民国4年卷5,13.
[5]清.吴谦.医宗金鉴.人民卫生出版社,1963,1644.
[6]胡伯虎.实用痔瘘学[M].北京：科技文献出版社,1988,231.
[7]管仲安.中医肛肠病证及现代治疗[M].山东：山东电子音像出版社,2009,139.
[8]林晖.上海中医药报,2005,07,08.
[9]Eisenhammer S The final evaluation and classification of the surgical treatment of the primary anorectal cryptoglandular intermuscular fistulous abscess and fistula.Dis Colon Rectum 1978;21:237-254
[10]赵自星.实用肛瘘学[M].成都：四川科技出版社,2003,160.
[11]张东铭.盆底与肛门病学[M].贵州科技出版社,2004.4：432.
[12]Tobin Ha KvarasND, lip augmentation using an alloderm graft.joral maxillofac surg,1998; 56:722-727.
[13]章蓓、李伯年.高位复杂性肛瘘30例的诊断和术式探讨[J].实用全科医生,2005,3(3)：207-208.
[14]黄乃健等中国肛肠病学[M].济南：山东科技出版社,1996,759-760.
[15]Takesue Y,Ohge H.Yokoyama T.etal.Long-term results of seton drainage on complex anal fistulae in patients with Crohn's disease[J].J Gastroenterol,2002,37(11):912-915.
[16]陆金根、曹永清等.隧道式拖线术治疗单纯性肛瘘的临床研究[J].中西医结合学报,2006,4(2)：140-146.
[17]何永恒、杨亲昭等.分段开窗旷置结合切扩挂线术治疗长瘘道高位复杂肛瘘[J].中国肛肠病杂志,1998,18(5)：18-19.
[18]梁健民.切挂开窗引流术治疗高位复杂性肛瘘的临床研究[J].大肠肛门病外科杂志,2000,6(2)：25-28.
[19]陈慧.开窗引流挂线术治疗复杂性肛瘘疗效观察[J].中华现代中西医杂志,2005,3(13)：1196-1197.
[20]王业皇、李柏年等.肛瘘旷置切开术与切开挂线术对肛门括约功能影响的对比研究[J].中国肛肠病杂志,1999,19(5)：9.
[21]韩震辉、孙建权.旷置挂线治疗高位肛瘘的临床观察[J].上海中医药杂志,2008,42(9)： 62.
[22]蒋干超、徐炳生等.复杂性肛瘘213例治疗体会[J].现代中西医结合杂志,2003,12(5)：501-502.
[23]李殿伟.切扩开窗旷置挂线术治疗高位复杂性肛瘘[J].中国中西结合外科杂志2000.6(：；)：198-199.
[24]丁克、姜春英、梅笑玲.肛瘘剔除挂线术治疗高位肛瘘[J].中国中西医结合外科杂志,1998.4(5)：306.
[25]李春雨.切开挂线对口引流治疗高位复杂性肛瘘治疗118例[J].中国肛肠病杂志,2001,21 (5)：23.
[26]梅笑玲、王立柱等.内口切开瘘管主道内端挂线术治疗高位肛瘘[J].中国肛肠病杂志,,2009,29(11)：59.
[27]申志强、孙俊秀.黄芪治疗选择性IgA缺乏的疗效[J].新药与临床,1997,16(4)：246-247.
[28]张艳、梁华平.黄芪多糖对烧伤小鼠细胞免疫功能的作用及机理探讨[J].中国实验临床免疫学杂志,1995,7(2)：41.
[29]任东林.有关高位复杂性肛瘘治疗的几个问题.广东医学,2001,22(12)：1093.
[1]赵自星.实用肛瘘学[M].成都：四川科技出版社,2003,160.
[2]胡伯虎.实用痔瘘学[M].北京：科技文献出版社,1988,231.
[3]隋.巢元方等《诸病源候论》.人民卫出版社.1984.
[4]宋.王怀隐等《太平圣惠方》.人民卫生出版社.1984.
[5]赵自星.实用肛瘘学[M].成都：四川科技出版社,2003,165.
[6]曹吉勋.中国痔瘘学[M].成都：四川科技出版社,1985,52.
[7]Lemis WG，Finan PJ，Holds worth PJ,et all Clinical results and manometric studies after rectal flap advancement for infra2levator trans2s phincteric fistula2in2 ano[J]. Int J Col orectal Dis,1995,10(4):189.
[8]Cir occo WC. Reilly JC1Challanging the p redictive accuracy of Goodsallπ s rule for anal fistulas[J].Dis Col on Rectum.1992.35(4):537.
[9]黄乃健等中国肛肠病学[M].济南：山东科技出版社,1996,729-766.
[10]Eisenhammer S The final evaluation and classification of the surgical treatment of the primary anorectal cryptoglandular intermuscular fistulous abscess and fistula.Dis Colon Rectum 1978:21:237-254.
[11]胡伯虎.大肠肛门病治疗学[M].北京：科技文献出版社,2001,315-317.
[12]陆德铭.中医外科学[M].上海：上海科学技术出版社,2002,188-193.
[13]Paks AG,GordonPH. Hardcastle JD.A classification of fistula in ano, Br J Surg, 1976,63,1-2.
[14]黄乃健等中国肛肠病学[M].济南：山东科技出版社,1996,729-766.
[15]胡伯虎.实用痔瘘学[M].北京：科技文献出版社,1988,231.
[16]Ratt o C, Gentile E.Merico M, et al 1How can the assessment of fistula2in2 ano be imp roved[J]. Dis Colon Rectum,2000.43(10):1375.
[17]Hancke E. Heintz A. Just M1 Diagnosis of anorectal fistula using magnetic res onance t omography[J].Chirurg.1993,64(9):720.
[18]范吾风、闫伟、公洁.有关促进创面愈合的外用中药的研究进展[J].中医外治杂 志,2003；12(6)：36.
[19]汤进友、李虹等.湿润烧伤膏治疗肛门直肠疾病术后创128例[J].中国烧伤疮疡杂志,2005；17(4)：301,302.
[20]胡洪铨、潘永梅.生肌玉红膏促进肛门疾病术后创面修复98例[J].湖南中医杂志,2006;22(6)：44-48.
[21]王军省、薛洁.柏红痔消外洗方应用于肛门病术后的疗效观察[J].中国中医药信息杂志,2004；11(5)：440.
[22]林晖.上海中医药报,2005.07.08.
[23]王业皇、李柏年、丁义江等.肛瘘旷置切开术与切开挂线术对肛门括约功能影响的对比研究[J].中国肛肠病杂志,1999,19(5)：9.
[24]李殿伟.切扩开窗旷置挂线术治疗高位复杂性肛瘘[J]..中国中西结合外科杂志2000,6(3)：198-199.
[25]丁克、姜春英、梅笑玲.肛瘘剔除挂线术治疗高位肛瘘[J].中国中西医结合外科杂志,1998,4(5)：306.
[26]李春雨.切开挂线对口引流治疗高位复杂性肛瘘治疗118例[J].中国肛肠病杂志2001,21(5)：23.
[27]Reznick RK, Bailey HR1 Closure of the internal opening for treat2 ment of comp lex fistula2in2 ano [J].DisCol on Rectum,1998,31(2):116.
[28]余苏萍.高位复杂性肛瘘手术前后盆底肌电图与肛管直肠压力测定的研究[J].中国肛肠病杂志,1998,18(5)：3.
[29]Lemis WG, Finan PJ, Holds worth PJ, et all Clinical results and manometric studies after rectal flap advancement for infra2levat or trans2s phincteric fistula2in2 ano[J]. Int J Colorectal Dis,1995,10(4):189.
[30]陆一、赵自星、安敏.改进肛瘘切缝内口(挂线)引流术治疗马蹄形肛瘘的临床观察[J].成都中医药大学学报,2000,23(2)：24.
[31]Osman BC1 Allπ swell that endswell:shakereareπs treat ment of anal fistula[J].Dis colon Rectum,1998,41 (7):914.
[32]唐学贵、李敏、吴至久等.切挂选择缝合术治疗高位复杂性肛瘘的临床及实验研究[J].中医药学刊,2005, 23(2)：3.
[33]Tobin Ha KvarasND, lip augmentation using an alloderm graft.joral maxillofac surg,1998:56:722-727.
[34]章蓓、李伯年.高位复杂性肛瘘30例的诊断和术式探讨[J].实用全科医生,2005,3(3)：207-208.
[35]黄乃健等中国肛肠病学[M].济南：山东科技出版社,1996,759-760.
[2]隋.巢元方.诸病源侯论.人民卫生出版社,1984.
[3]陈红风.中医外科学.中国中医药出版社,2005,476.
[4]明.陈文治.疡科选粹.上海：上海新中华书社,扫叶山房石印本,中华民国4年卷5,13.
[5]清.吴谦.医宗金鉴.人民卫生出版社,1963,1644.
[6]胡伯虎.实用痔瘘学[M].北京：科技文献出版社,1988,231.
[7]管仲安.中医肛肠病证及现代治疗[M].山东：山东电子音像出版社,2009,139.
[8]林晖.上海中医药报,2005,07,08.
[9]Eisenhammer S The final evaluation and classification of the surgical treatment of the primary anorectal cryptoglandular intermuscular fistulous abscess and fistula.Dis Colon Rectum 1978;21:237-254
[10]赵自星.实用肛瘘学[M].成都：四川科技出版社,2003,160.
[11]张东铭.盆底与肛门病学[M].贵州科技出版社,2004.4：432.
[12]Tobin Ha KvarasND, lip augmentation using an alloderm graft.joral maxillofac surg,1998; 56:722-727.
[13]章蓓、李伯年.高位复杂性肛瘘30例的诊断和术式探讨[J].实用全科医生,2005,3(3)：207-208.
[14]黄乃健等中国肛肠病学[M].济南：山东科技出版社,1996,759-760.
[15]Takesue Y,Ohge H.Yokoyama T.etal.Long-term results of seton drainage on complex anal fistulae in patients with Crohn's disease[J].J Gastroenterol,2002,37(11):912-915.
[16]陆金根、曹永清等.隧道式拖线术治疗单纯性肛瘘的临床研究[J].中西医结合学报,2006,4(2)：140-146.
[17]何永恒、杨亲昭等.分段开窗旷置结合切扩挂线术治疗长瘘道高位复杂肛瘘[J].中国肛肠病杂志,1998,18(5)：18-19.
[18]梁健民.切挂开窗引流术治疗高位复杂性肛瘘的临床研究[J].大肠肛门病外科杂志,2000,6(2)：25-28.
[19]陈慧.开窗引流挂线术治疗复杂性肛瘘疗效观察[J].中华现代中西医杂志,2005,3(13)：1196-1197.
[20]王业皇、李柏年等.肛瘘旷置切开术与切开挂线术对肛门括约功能影响的对比研究[J].中国肛肠病杂志,1999,19(5)：9.
[21]韩震辉、孙建权.旷置挂线治疗高位肛瘘的临床观察[J].上海中医药杂志,2008,42(9)： 62.
[22]蒋干超、徐炳生等.复杂性肛瘘213例治疗体会[J].现代中西医结合杂志,2003,12(5)：501-502.
[23]李殿伟.切扩开窗旷置挂线术治疗高位复杂性肛瘘[J].中国中西结合外科杂志2000.6(：；)：198-199.
[24]丁克、姜春英、梅笑玲.肛瘘剔除挂线术治疗高位肛瘘[J].中国中西医结合外科杂志,1998.4(5)：306.
[25]李春雨.切开挂线对口引流治疗高位复杂性肛瘘治疗118例[J].中国肛肠病杂志,2001,21 (5)：23.
[26]梅笑玲、王立柱等.内口切开瘘管主道内端挂线术治疗高位肛瘘[J].中国肛肠病杂志,,2009,29(11)：59.
[27]申志强、孙俊秀.黄芪治疗选择性IgA缺乏的疗效[J].新药与临床,1997,16(4)：246-247.
[28]张艳、梁华平.黄芪多糖对烧伤小鼠细胞免疫功能的作用及机理探讨[J].中国实验临床免疫学杂志,1995,7(2)：41.
[29]任东林.有关高位复杂性肛瘘治疗的几个问题.广东医学,2001,22(12)：1093.
[1]赵自星.实用肛瘘学[M].成都：四川科技出版社,2003,160.
[2]胡伯虎.实用痔瘘学[M].北京：科技文献出版社,1988,231.
[3]隋.巢元方等《诸病源候论》.人民卫出版社.1984.
[4]宋.王怀隐等《太平圣惠方》.人民卫生出版社.1984.
[5]赵自星.实用肛瘘学[M].成都：四川科技出版社,2003,165.
[6]曹吉勋.中国痔瘘学[M].成都：四川科技出版社,1985,52.
[7]Lemis WG，Finan PJ，Holds worth PJ,et all Clinical results and manometric studies after rectal flap advancement for infra2levator trans2s phincteric fistula2in2 ano[J]. Int J Col orectal Dis,1995,10(4):189.
[8]Cir occo WC. Reilly JC1Challanging the p redictive accuracy of Goodsallπ s rule for anal fistulas[J].Dis Col on Rectum.1992.35(4):537.
[9]黄乃健等中国肛肠病学[M].济南：山东科技出版社,1996,729-766.
[10]Eisenhammer S The final evaluation and classification of the surgical treatment of the primary anorectal cryptoglandular intermuscular fistulous abscess and fistula.Dis Colon Rectum 1978:21:237-254.
[11]胡伯虎.大肠肛门病治疗学[M].北京：科技文献出版社,2001,315-317.
[12]陆德铭.中医外科学[M].上海：上海科学技术出版社,2002,188-193.
[13]Paks AG,GordonPH. Hardcastle JD.A classification of fistula in ano, Br J Surg, 1976,63,1-2.
[14]黄乃健等中国肛肠病学[M].济南：山东科技出版社,1996,729-766.
[15]胡伯虎.实用痔瘘学[M].北京：科技文献出版社,1988,231.
[16]Ratt o C, Gentile E.Merico M, et al 1How can the assessment of fistula2in2 ano be imp roved[J]. Dis Colon Rectum,2000.43(10):1375.
[17]Hancke E. Heintz A. Just M1 Diagnosis of anorectal fistula using magnetic res onance t omography[J].Chirurg.1993,64(9):720.
[18]范吾风、闫伟、公洁.有关促进创面愈合的外用中药的研究进展[J].中医外治杂 志,2003；12(6)：36.
[19]汤进友、李虹等.湿润烧伤膏治疗肛门直肠疾病术后创128例[J].中国烧伤疮疡杂志,2005；17(4)：301,302.
[20]胡洪铨、潘永梅.生肌玉红膏促进肛门疾病术后创面修复98例[J].湖南中医杂志,2006;22(6)：44-48.
[21]王军省、薛洁.柏红痔消外洗方应用于肛门病术后的疗效观察[J].中国中医药信息杂志,2004；11(5)：440.
[22]林晖.上海中医药报,2005.07.08.
[23]王业皇、李柏年、丁义江等.肛瘘旷置切开术与切开挂线术对肛门括约功能影响的对比研究[J].中国肛肠病杂志,1999,19(5)：9.
[24]李殿伟.切扩开窗旷置挂线术治疗高位复杂性肛瘘[J]..中国中西结合外科杂志2000,6(3)：198-199.
[25]丁克、姜春英、梅笑玲.肛瘘剔除挂线术治疗高位肛瘘[J].中国中西医结合外科杂志,1998,4(5)：306.
[26]李春雨.切开挂线对口引流治疗高位复杂性肛瘘治疗118例[J].中国肛肠病杂志2001,21(5)：23.
[27]Reznick RK, Bailey HR1 Closure of the internal opening for treat2 ment of comp lex fistula2in2 ano [J].DisCol on Rectum,1998,31(2):116.
[28]余苏萍.高位复杂性肛瘘手术前后盆底肌电图与肛管直肠压力测定的研究[J].中国肛肠病杂志,1998,18(5)：3.
[29]Lemis WG, Finan PJ, Holds worth PJ, et all Clinical results and manometric studies after rectal flap advancement for infra2levat or trans2s phincteric fistula2in2 ano[J]. Int J Colorectal Dis,1995,10(4):189.
[30]陆一、赵自星、安敏.改进肛瘘切缝内口(挂线)引流术治疗马蹄形肛瘘的临床观察[J].成都中医药大学学报,2000,23(2)：24.
[31]Osman BC1 Allπ swell that endswell:shakereareπs treat ment of anal fistula[J].Dis colon Rectum,1998,41 (7):914.
[32]唐学贵、李敏、吴至久等.切挂选择缝合术治疗高位复杂性肛瘘的临床及实验研究[J].中医药学刊,2005, 23(2)：3.
[33]Tobin Ha KvarasND, lip augmentation using an alloderm graft.joral maxillofac surg,1998:56:722-727.
[34]章蓓、李伯年.高位复杂性肛瘘30例的诊断和术式探讨[J].实用全科医生,2005,3(3)：207-208.
[35]黄乃健等中国肛肠病学[M].济南：山东科技出版社,1996,759-760.