论著
甲字提毒粉药条换药法配合切开对口引流术治疗后位马蹄形肛瘘78例
张祎，董 毅，宋长满
【摘要】 目的 分析和探讨中药甲字提毒粉配合切开对口引流术（Hanley手术）治疗后位马蹄形肛瘘的临床效果，为临床治疗方案的选择提供依据。方法 将78例后位马蹄形肛瘘患者随机分成两组（每组39例）：治疗组以中药甲字提毒粉药条配合Hanley手术进行治疗，对照组常规行改良Hanley手术，并配合术后凡士林纱条换药。对比两组患者的临床治疗效果、创面恢复时间、住院时间以及随访复发情况。
【关键字】 甲字提毒粉,后位马蹄形肛瘘,肛门后深间隙,Hanley手术
中图分类号：文献标识码：文章编号：
[Abstract] Objective To analyze and discuss the traditional Chinese medicine Jiazitidufen combined with incision and drainage in treatment of Posterior horseshoe fistula. Methods 78 patients were randomly divided into 2 groups (39 cases in each group):The treatment group was treated with Jiazitidufen drug strip and Hanley operation, the control group received Hanley operation combined with petrolatum gauze.Clinical comparative study of the therapeutic effect of two groups of patients including wound recovery time,hospital stay,as well as follow up recurrence were performde in the study. Results The clinical cure rate of the treatment group was better than that of the control group, the total effective rate was 97.44%in the treatment group ,The total effective rate was 87.18% in the control group, the treatment group was significantly higher（P<0.05）。Conclusion The treatment of Jiazitidufen drug stick combined with Hanley operation has higher cure rate . The healing time of the wound was shortened obviously.
马蹄形肛瘘是肛肠外科常见疑难病之一。后位马蹄形肛瘘属于复杂性肛瘘,瘘道向肛门两侧呈环状走行形似马蹄,故称为马蹄形肛瘘[ ]。典型的马蹄形肛痿,位置在肛提肌以下,其起源虽然来自肛门6点位感染的肛隐窝,但是瘘道往往向头侧深部蔓延置肛门后深间隙,炎症呈环形向两侧坐骨直肠窝蔓延,形成马蹄形。肛门后深间隙的解剖特点及马蹄形肛瘘的病理解剖限制了这一区域的术后切口愈合效果，肛门后深间隙本身就是一个较难识别及暴露的区域。同样因为肛门后深间隙的特殊解剖学结构，导致了术后的后正中切口的愈合也是困难的，经常会出现术后切口假性愈合，导致残腔出现或形成脓肿[ ]。2011年11月至2017年10月，我们用甲字提毒粉药条脱管法配合切开对口引流术（Hanley手术）治疗后位马蹄形肛瘘78例收到满意疗效，现报告如下。
1资料与方法
1.1诊断标准
参照肛瘘临床诊治指南（2006版）[ ]拟定①反复发作的肛周肿痛、流脓，急性炎症期可发热；②局部检查视诊见肛周单侧或两侧有两个以上的外口，触诊可扪及外口之间有条索状物相连并延伸至截石位6点，肛管直肠环后半圈多变硬失去弹性，外口表面凹凸不平，有不同程度的肉芽增生和少量脓性分泌物外溢；③使用探针或，亚甲蓝瘘管染色或肛周MRI、X线瘘道造影、直肠腔内超声等特殊检查证实，瘘管主管在肛提肌以上环形或半环形围绕肛管，内口在截石位6点。