目的 探讨高位盲瘘的微创治疗方法,研究脱细胞真皮基质在高位盲瘘治疗中的应用价值.方法 39例高位盲瘘患者,手术分2期进行,经括约肌或括约肌间肛瘘合并高位盲瘘Ⅰ期齿线下瘘管切开、内口挂线并高位盲瘘旷置引流,括约肌上肛瘘切开内口并高位盲瘘旷置引流;Ⅱ期高位盲瘘脱细胞真皮基质填塞治疗.观察Ⅱ期手术时间、术中出血、术后疼痛、住院总天数、住院总费用及复发率等临床及相关指标.结果 39例患者中有26例获得Ⅰ期治愈,13例患者治疗失败,改行肛瘘切开挂线术后痊愈.高位盲瘘脱细胞真皮填塞术手术治愈率66.7%.括约肌上并发高位盲瘘治愈2例,治愈率100%,经括约肌并发高位盲瘘治愈6例,治愈率50%,括约肌间并发高位盲瘘治愈18例,治愈率72%.结论 应用脱细胞真皮基质材料治疗高位盲瘘具有损伤小、愈合时间短、肛门失禁率低、外形保留好等优势,值得进一步推广.%Objective To investigate the minimally invasive treatment of high blind fistula, acellular dermal matrix in the high blind fistula treatment value. Methods high blind fistula two cases: 39 cases of patients with high blind fistula, anal sphincter, sphincter anal fistula complicated by high blind fistula of 12 cases, anal sphincter between concurrent high blind fistula of 25 cases. Operation in two, fistulotomy anal sphincter or sphincter merge high blind fistula I of the dentate line, inside the mouth hung high blind fistula exclusion drainage, anal sphincter incision inside the mouth and the high blind fistula exclusion fistula drainage; II high blind acellular dermal matrix filling treatment observation period II surgery time, blood loss, postoperative pain, total hospital days, hospital clinical and related indicators of the total cost and the relapse rate. Results 39 patients, 26 cases of a cure, 13 cases of treatment failure in patients diverted a-nal incision recover after he hung up. High blind fistula acellular dermal filling operation cure rate of 66. 7%. Sphincter concurrent high blind fistula cured two cases, the cure rate of 100%, and concurrent high blind fistula cured six cases, the cure rate of 50% through the sphincter, the sphincter between concurrent high blind fistula cured 18 cases, the cure rate of 72%. Conclusion The acellular dermal matrix material treatment of high blind fistula damage, healing time is short, fecal incontinence is low, shape retention to good advantage, worthy of further promotion.
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