Objective To investigate the safety and effectiveness of the operation of integrate subparagraph, fenestration, exclusion, cut expansion, seton, tube, and drainage (ISFECSTD) to cure complex anal fistula. Methods Using randomized comparison and multicenter parallel experiment, the total number was 240: 120 patients in study group treated by ISFECSTD, and 120 patients in control group treated by extended cutting and seton operation. Then compared the safety and effectiveness between two groups. Results The clinical recovery rate of the study group was significantly higher than that in the control group （Plt;0.05）. The operation time and wound healing time in study group were significantly less than those in control group, and the scar area after wound healing was smaller than that in control group （Plt;0.01）. The decreased extents of anorectal pressures and rectal capacity feeling function after operation in study group were smaller than those in control group (Plt;0.01). Rectal and anal reflex function and healing of the endostoma, stem, and branch in study group were better than those in control group (Plt;0.05, Plt;0.01). Incidence of anal incontinence after operation in study group was significantly less than that in of anus-rectum structure and function, and has the merits of higher cure rate, shorter time of healing, smaller scar, less pain, etc. The method of ISFECSTD is worth being a new standardized operation in the clinical application.
目的 观察和评估一期手术治疗肛门直肠周围脓肿的临床疗效。方法 回顾性分析我院2001年1月至2006年10月期间107例实施一期手术的肛门直肠周围脓肿患者的临床资料。结果 所有患者均行一次性根治手术，术后切口换药。住院时间9～28 d，平均18.5 d。术后随访3～36个月，平均19.5个月，1例术后形成瘘管，2例术后脓肿复发，此3例经再次手术治愈，无复发； 术后一次性治愈率达97.2%（104/107）。结论 一期手术治疗肛门直肠周围脓肿较单纯切开引流手术能明显地缩短术后感染控制时间，降低术后脓肿的复发率和肛瘘的发生率，减轻患者的痛苦。
Eighteen paticnts (17 females and 1 male ) with acguired preanal fistula were treated surgically. The ages ranged from 4 months to 12 years. Their locations were between the anorectum and the vestibulum (12 cases), the anorectum and the labia (2 cases), the anorectum and the vagina (3 cases), and the anorectum and the urethra (1 case). All of them were tueated by intraectal repair. The surgical procedures were briefly discused. The operation could be used in all types of acquired preanal fistula and has no danger of trauma to the anal sphincter and posterior vaginal wall. A long term follow-up study of 7 patients showed that there was a cure in 18 cases with normal function.
目的 观察医用伤口修复液对肛瘘患者术后创面修复的临床疗效。方法 将78例行手术治疗的肛瘘患者随机分为2组，试验组39例，予以医用伤口修复液纱条换药，1次/d，至创面愈合；对照组39例，予以无菌凡士林纱布换药，1次/d，至创面愈合。比较2组患者的创面渗液明显减少时间、出血情况，换药时创面疼痛评分及创面愈合时间。结果 试验组的创面疼痛评分、创面渗液明显减少时间、创面愈合时间及发生创面出血的比例均短于或低于对照组，其差异均具有统计学意义（P＜0.05）。所有患者均未发生不良反应。结论 医用伤口修复液对肛瘘患者术后创面修复具有较好的临床疗效。
Objective To evaluate the value of magnetic resonanace imaging (MRI) on the diagnosis of complex anal fistula. Methods The preoperative digital examination and MRI with the phased-array coil were implemented for 22 patients who were clinically suspected with complex anal fistula. The final diagnosis were based on surgical findings. Outcomes of MRI and digital examination were compared with surgical results. Results Eighteen patients were diagnosed as complex anal fistula, 1 case of presacral cyst and 3 cases of chronic anorectal fistula combined with perianal mucinous adenocarcinoma. All the patients were correctly diagnosed by MRI, while the patients with presacral cyst and perinaal mucinous adenocarcinoma could not be diagnosed correctly by digital examination. According to the Parks classification, 3 patients suffered from transsphincteric fistula, 11 cases of supra-sphincteric and 5 cases of extra-sphincteric fistula. The diagnosis rates of the internal opening with digital examination and MRI were 33.3% and 72.2%, the rates of the primary tract were 83.3% and 100%, and the rates of the secondary extensions were 16.7% and 88.9%, respectively. The differences in detection of internal opening and secondary extensions between MRI and digital examination were significant (P=0.019, P=0.000), the difference in detection of primary tract was no significant (P=0.072). Conclusion MRI with the phased-array coil can develope the high accuracy in the diagnosis of complex anal fistulas, and reveal the relationship between anorectal sphincters and the complex fistula.
Objective To compare the clinical effect between alginate calcium dressing and radix yarn dressing after anal fistula surgery. Methods A survey of 128 patients with anal fistula from April to October 2008 were studied. Patients were divided into two groups using a simple random method: 64 cases in therapy group which were treated with alginate calcium dressing and 64 cases in control group which were treated with traditional radix yarn dressing. The difference of the wound recovery indexes between two groups was compared.Results With regard to age, gender, anal fistula type, the proportion of preoperative diabetes and the diameter of wound, there was no statistical significance between therapy group and control group (Pgt;0.05). The proportion of slight pain during dressing change in therapy group (45.32%, 29/64) was more than control group (25.00%, 16/64), which had statistical significance (Pgt;0.05). The incidence of skin allergy was significantly different between two groups (29.69% vs. 60.94%, P＜0.05). Also, the rotten tissue and the soakage disappears with a shorter period, which both had statistical significance 〔(8.60±2.37) d vs. (12.22±3.29) d， (16.96±5.83) d vs. (22.02±5.90) d〕， Plt;0.05.Conclusion With the shorten of inflammatory and increment stage of the wound recovery, alginate calcium dressing is an ideal material for the postoperative duration of surgery of anal fistula.
ObjectiveTo explore the influence of individualized psychological nursing in perioperative patients with high complex anal fistula on their perioperative anxiety, depression, pain, and recovery. MethodsFifty-seven perioperative patients with high anal fistula treated between May 2011 and March 2012 were randomly divided into observation group (n=28) and control group (n=29). Patients in the control group were treated with traditional way of psychological nursing intervention, while patients in the observation group were given individualized psychological nursing intervention. Then, we compared the two groups of patients in terms of their perioperative anxiety, depression, and pain as well as the length of hospital stay, hospital expenses, wound healing time, and patients' quality of life. ResultsOn the day of surgery and on day 7 after surgery, anxiety, depression and pain scores of the observation group were significantly lower than those of the control group (P<0.05). Length of hospital stay and hospitalization expenses of the observation group were significantly shorter or less than the control group (P<0.05). There was no statistically significant diTherence between the two groups in postoperative wound healing time (P>0.05). The quality of life score for both the two groups of patients after treatment was significantly higher than that before treatment (P<0.05), but there was no statistically significant diTherence between the two groups (P>0.05). ConclusionIndividualized psychological nursing can relieve perioperative adverse psychological reactions such as anxiety, depression and pain, and promote postoperative recovery for patients with high complex anal flstula.