目的：观察和评价高挂低切旷置引流术治疗高位复杂性肛瘘的临床疗效。方法方便选取2010年10月＿2014年12月该院肛肠科高位复杂性肛瘘的患者60例,按随机数字表法分为30例对照组和30例治疗组,治疗组采用高挂低切旷置引流术。对照组采用传统高挂低切术治疗。分别记录两组患者术后总的治疗效果、术后第1、3和7d创面疼痛值、术后肛门创面面积大小、术后肛门创面痊愈时间、肛门创面痊愈后瘢痕面积大小及复发情况。结果治疗组总有效率为100％,对照组总有效率为100％,两组比较差异无统计学意义(P>0.05)；但治疗组患者手术后第1、3、7天术后肛门疼痛比较(6.05±0.74)、(4.60±0.51)、(1.93±0.39﹚分低于对照组(9.26±0.84)、(7.34±0.64)、(3.57±0.56﹚分,两组比较差异有统计学意义(P<0.05)；治疗组的术后肛门创面面积及肛门创面痊愈后瘢痕面积比较(6.09±1.08﹚cm2及(4.56±0.62﹚cm2低于对照组(9.67±1.96)cm2及(7.97±1.24﹚cm2,两组比较差异有统计学意义(P<0·05)；治疗组患者伤口愈合时间[(22.93±0.59)d短于对照组(34.47±1.16)d,两组比较差异有统计学意义(P<0.05)；两组间在术后肛门括约肌功能及肛瘘复发方面比较差异无统计学意义(P>0.05),治疗组30例均无肛门失禁,对照组1例轻度失禁,两者差异无统计学意义。结论高挂低切旷置引流术能够减少手术创伤,尽可能地保护肛周皮肤,缩短伤口愈合时间,能最大限度保持肛门节制功能,减少术后并发症,减少术后肛门疤痕面积,在临床应用上有独到之处。%Objective To observe and assess the clinical effect of integrating free and high put, low cut and expanding with tubing drainage for high complicated anal fistulas.Methods 60 patients in our hospital from October 2010 to December 2014 with high complicated anal fistulas were randomly divided into treatment group (n=30) and control group (n=30).The control group was treated with integrating free and high put, low cut and expanding with tubing drainage.The control group was treated with drainage traditional high up low cut.Were recorded in two groups of patients after total curative effect, postoperative anal size, postoperative anal wound healing time, postoperative pain, anal wound at first, tird and seventh days after operation, size and recurrence of scar area.Results The total effective rate of treatment group was 100%, the control group total effective rate was 100%, there was no statistical difference between the two groups (P>0.05); But the treatment group after operationt first, tird and seventh days postoperative anal pain compared [(6.05 ±0.74), (4.60 ±0.51), (1.93 ±0.39 points)] lower than the control group [(9.26±0.84), (7.34±0.64), (3.57±0.56) points],The difference between the two groups was statistically significant (P<0.05); Compared with the control group (6.09±1.08)cm2 and (9.67± 1.96)cm2 (4.56±0.62)cm2 and (7.97 ±1.24)cm2 in treatment group, the wound area and scar area after operation were lower than that of control group, the difference between the two groups was statistically significant (P< 0.05); In wound healing time,patients in the treatment group were shorter than the control group (22.93 ±0.59) days [(34.47 ±1.16) days], the difference between the two groups was statistically significant (P< 0.05).Conclusion Professor Deng's therapy for high complicated anal fistulas with in-tegrating free and high put, low cut and expanding with tubing drainage not only can contribute to reduce surgical trauma, protect the perianal skin, reduce wound healing time, but also maintain anal function, reduce postoperative complications and reduce postoperative anal scar area due to the intraoperative protection of the anal sphincter. So this method has unique clinical applications.
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