王慧娟^1,,
冯晓兰¹,
王常生^2,,,
杨军³
1. 张家口市第五医院 妇产科, 河北 张家口 075000
2. 张家口市第五医院 肛肠科, 河北 张家口 075000
3. 张家口市第五医院 放射科, 河北 张家口 075000

基金项目: 河北省张家口市科技计划外科研项目(1621046D)


详细信息 作者简介: 王慧娟(1981-), 女, 副主任医师。E-mail:827460086@qq.com




通讯作者: 王常生, 副主任医师。E-mail:416631451@qq.com 中图分类号: R657.1


摘要:目的探讨在中低位直肠阴道瘘手术治疗中应用藏线缝合法结合生物补片技术的效果及优势。方法选取2015年8月至2019年3月间张家口第五医院收治的中低位直肠阴道瘘患者38例，根据治疗方式不同分为新型补片组(n=19)和对照组(n=19)。对照组采用传统的人体黏膜修复术式配合间断缝合治疗方法，新型补片组采用新型生物补片技术结合藏线缝合法的治疗术式，两组连续治疗并在1年后随访，比较两组患者的术后血清炎症因子水平、术后并发症、住院时间及复发率等情况。结果新型补片组和对照组的术后血清炎症因子CRP(mg/L)、TNF-α(μg/L)、PCT(μg/L)、HMGB-1(μg/L)分别为(68.34±7.65，473.34±62.52，7.35±0.79，8.20±0.93)和(112.21±21.24，524.14±78.23，12.00±1.43，14.71±1.93)，新型补片组均显著低于对照组(P < 0.05)。新型补片组和对照组的术后并发症发生率分别为5.26%和31.56%，新型补片组明显低于对照组(P < 0.05)。两组患者的住院时间无统计学差异(P>0.05)。1年后随访，新型补片组和对照组的复发率分别为5.26%和21.05%，两组差异有统计学意义(P < 0.05)。结论采用藏线缝合法结合生物补片治疗中低位直肠阴道瘘，不仅能解决传统术式中张力大、易感染的问题，而且能有效避免因肛管缺损造成的功能丧失，减少复发。
关键词: 藏线缝合法/
生物补片/
中低位直肠阴道瘘


Abstract:ObjectiveTo investigate the effect and advantage of the combination of suture and biological mesh in the surgical treatment of middle and low rectovaginal fistula.MethodsA total of 38 clinical cases of middle and low rectovaginal fistula admitted to the Fifth Hospital of Zhangjiakou between August 2015 and March 2019 were selected and divided into the new patch group (n=19) and the control group (n=19) according to different treatment methods. The control group was treated with traditional human mucosal repair combined with interrupted suture treatment; and the new patch group was treated with new biological patch technique combined with hidden line suture repair. The patients were followed up after 1 year of surgery. The postoperative serum levels of inflammatory cytokines, postoperative complications rate, recurrence rate, and hospitalization time were compared between the two groups.ResultsThe serum inflammatory factors CRP (mg/L), TNF-α (μg/L), PCT (μg/L) and HMGB-1 (μg/L) were (68.34±7.65, 473.34±62.52, 7.35±0.79, 8.20±0.93) and (112.21±21.24, 524.14±78.23, 12.00±1.43, 14.71±1.93) in the new patch group and the control group, respectively. The levels were significantly lower in the new patch group than those in the control group (P < 0.05). The incidence of postoperative complications in the new patch group and the control group was 5.26% and 31.56%, respectively (P < 0.05). There was no significant difference in hospital stay between the two groups (P>0.05). At 1-year follow-up, the recurrence rates of the new patch group and the control group were 5.26% and 21.05%, respectively (P < 0.05).ConclusionsIn the treatment of middle and low rectovaginal fistula, the combination of suture and biological patch can not only solve the problem of high tension and easy infection in traditional operation, but also effectively avoid the loss of function caused by anal defects and reduce recurrence.
Keywords:hidden line suture repair treatment/
biological patch/
middle and low rectovaginal fistulas

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