目的:研究改良经肛括约肌间切开术(TROPIS)联合消炎止痛方(外洗1号方)坐浴在高位复杂性肛瘘中的应用效果。方法:纳入2021年1月—2022年12月就诊于于安庆市中医医院肛肠科的110例高位复杂性肛瘘患者，采用随机数字表法分为坐浴组和手术组，各55例。手术组给予改良TROPIS术治疗，坐浴组行改良TROPIS联合消炎止痛方坐浴治疗。比较两组患者临床疗效(创面愈合时间、痊愈率、复发率)，于术前和术后3个月，记录并比较两组患者中医症状积分、肛肠动力学、肛门功能[大便失禁量表(Wexner评分)]及生活质量[排便失禁生活质量(FIQL)评分]差异，比较两组患者治疗期间不良反应(出血、感染、尿潴留、排便障碍)发生情况。结果:坐浴组的创面愈合时间短于手术组[(13.62±1.46)d vs (17.67±1.86)d]，复发率低于手术组(1.82% vs 14.55%)(P 均<0.05)，分泌物浸透纱布个数低于手术组[(16.80±2.15)个 vs (29.63±2.48)个]，分泌物pH值高于手术组[(8.40±0.68) vs (6.56±0.99)]，差异均有统计学意义；坐浴组的痊愈率与手术组无统计学差异(94.55% vs 90.91%, P >0.05)；术后3个月，两组RRP、MTV、RC水平升高，且坐浴组RRP(2.07±0.47)kPa、MTV(192.55±17.31)mL、RC(4.08±1.12)mL/mmHg均高于手术组(1.84±0.43)kPa、(168.94±15.77)mL、(3.27±1.02)mL/mmHg；术后3个月，两组患者ARP水平、瘙痒、肿痛及流脓评分、Wexner评分、FIQL评分均较治疗前降低，且坐浴组ARP(7.18±1.04)kPa、瘙痒(1.62±0.27)分、肿痛(1.41±0.25)分、流脓(1.37±0.21)分、Wexner评分、FIQL评分均低于手术组ARP(79.42±1.13)kPa、瘙痒(1.85±0.31)分、肿痛(1.59±0.22)分、流脓(1.65±0.24)分，差异均有统计学意义(P <0.05)；两组患者不良反应发生率无显著性差异(P >0.05)。结论:改良TROPIS联合消炎止痛方(外洗1号方)坐浴可有效促进高位复杂性肛瘘患者创面愈合，改善术后肛门功能及生活质量。
Application of modified transanal opening of intersphincteric space combined with Xiaoyan Zhitong prescription sitz bath in high complex anal fistula
ZHANG Qing,ZHU Yong,WANG Yong-yang
Abstract:
Objective To explore the application of modified transanal opening of intersphincteric space (TROPIS) combined with Xiaoyan Zhitong prescription (external washing No.1 prescription) sitz bath in high complex anal fistula. Methods 110 patients with high complex anal fistula in our hospital were selected from January 2021 to December 2022, and the patients were randomized into sitting bath group (55 cases) and surgical group (55 cases) by random number table method. The surgical group was treated with modified TROPIS, while the sitting bath group was given modified TROPIS combined with Xiaoyan Zhitong prescription sitz bath. The clinical efficacy (wound healing time, cure rate and recurrence rate) was compared. The differences in TCM symptoms scores, anorectal dynamics and quality of life [Fecal Incontinence Quality of Life (FIQL)] were recorded before surgery and at 3 months after surgery. The adverse reactions (bleeding, infection, urinary retention, defecation disorder) during treatment were statistically analyzed. Results The wound healing time in sitting bath group with (13.62±1.46)d was shorter than (17.67±1.86)d in surgical group, the number of gauze soaked with secretions (16.80±2.15)was lower than that in the surgical group (29.63±2.48), and the pH value of secretions (8.40±0.68)was higher than that in the surgical group (6.56±0.99), and the recurrence rate was lower compared to surgical group (1.82% vs 14.55%)(P <0.05). There was no significant difference in cure rate between the two groups(94.55% vs 90.91%) (P >0.05). The RRP, MTV and RC were risen in both groups at 3 months after surgery, and the indicators with (2.07±0.47)kPa, (192.55±17.31)mL and (4.08±1.12)mL/mmHg in sitting bath group group were higher than (1.84±0.43)kPa, (168.94±15.77)mL and (3.27±1.02)mL/mmHg in surgical group. At 3 months after surgery, the ARP and scores of pruritus, swelling pain and pus, Wexner scores and FIQL scores in the two groups were declined compared with those before treatment, and the ARP and scores of pruritus, swelling and pain, and purulent discharge in sitting bath group with (7.18±1.04)kPa, (1.62±0.27)points, (1.41±0.25)points, (1.37±0.21)points, were lower than (79.42±1.13)kPa, (1.85±0.31)points, (1.59±0.22)points, (1.65±0.24)points in surgical group (P <0.05). There were no significant differences in the incidence rates of adverse reactions between groups (P >0.05). Conclusion Modified TROPIS combined with Xiaoyan Zhitong prescription (external washing No.1 prescription)sitz bath can effectively promote wound healing, and improve postoperative anal function and quality of life in patients with high complex anal fistula.
