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Objective:To investigate the clinical diagnostic value of MRI retention enema cannula enhanced scanning in the high complex anal fistula.Methods:The clinical data of 60 anal fistula patients underwent surgery treatment from May 2020 to May 2022 in Affiliated Hospital of Shanxi University of Traditional Chinese Medicine were retrospectively analyzed. All patients underwent MRI plain scanning and enhanced scanning before operation. Compared with the surgical results, the difference between MRI plain scanning and enhanced scanning in the diagnosis of high complex anal fistula was compared.Results:All of the 60 patients successfully completed surgical treatment, and 58 cases internal orifices, 55 cases complex anal fistulas and 53 cases high anal fistulas were found intraoperatively. MRI plain scanning results showed 32 cases internal orifices, 46 cases complex anal fistulas and 42 cases high anal fistulas were found. MRI enhanced scanning results showed 54 cases internal orifices, 53 cases complex anal fistulas and 50 cases high anal fistulas were found. Based on surgical results, the coincidence rates of internal orifice, complex anal fistula and high anal fistula in MRI enhanced scanning were significantly higher than those in MRI plain scanning: 93.10% (54/58) vs. 55.17% (32/58), 96.36% (53/55) vs. 83.64% (46/55) and 94.34% (50/53) vs. 79.25% (42/53), and there were statistical differences ( χ2 = 21.76, 4.95 and 5.27; P<0.01 or <0.05). Conclusions:The MRI retention enema cannula enhanced scanning has obvious advantages in the diagnosis of high complex anal fistula, which provides scientific reference value for the diagnosis and operation of high complex anal fistula in clinic.
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Objective:To investigate the therapeutic effect of open suture and selective suture in patients with high complexity anal fistula and its effect on anal function and complications.Methods:Prospectively selected 174 patients with high complex anal fistula who were hospitalized in the Anorectal Surgery Department of the Second People′s Hospital of Yibin City from December 2018 to December 2021 as the study subjects, including 138 males and 36 females, aged from 26 to 45 years, with an average of (35.20 ± 8.86) years. According to the admission order of patients, grouped them into single and double numbers, with single numbers being the control group ( n=87) and double numbers being the observation group ( n=87). The control group was treated with traditional incision and thread hanging therapy, while the observation group was treated with selective suture through incision and thread hanging therapy. Compared the surgical time, blood loss, surgical cost, wound healing time, and anal function at 6 months after surgery between the two groups of patients. Compared the treatment effects of two groups of patients at 6 months after surgery. Compared the postoperative complications within 6 months and recurrence within 1 year between the two groups. The measurement data subject to normal distribution were expressed by mean ± standard deviation( ± s). The two groups were compared by independent sample t test, and the count data were compared by Chi-square test. Rank sum test was used for comparison of hierarchical data. Results:The surgical time in the observation group was higher than that in the control group [(44.30 ± 8.11) min vs (42.18 ± 7.25) min, ( t=-2.44, P<0.05], and the surgical cost was higher than that in the control group [(1184.81 ± 372.68) yuan vs (835.28 ± 320.03) yuan, t=-8.75, P<0.001]. There was no statistically significant difference in blood loss data between the two groups [(19.57 ± 6.07) mL vs (18.35 ± 5.25) mL, t=-1.88, P>0.05]. The length of wound healing time in the observation group was lower than that in the control group [(24.18 ± 4.35) d vs (29.35 ± 5.08) d, t=11.09, P<0.001]. The anal function score of the observation group at 6 months after surgery was lower than that of the control group [(4.80 ± 1.21) score vs (6.71 ± 1.35) score, t=14.72, P<0.001]. All patients did not experience any loss of follow-up. In the comparison of treatment effects 6 months after surgery, the observation group had a better efficacy rating than control group ( Z=3.86, P<0.001). At 6 months after surgery, the incidence of complications in the observation group was lower than that in the control group [2.30% (2/87) vs 10.34% (9/87), χ2=4.76, P<0.05]. One year after surgery, the recurrence rate in the observation group was lower than that in the control group [2.30% (2/87) vs 10.34% (9/87), χ2=4.76, P<0.05]. Conclusion:The application of incision and thread-drawing selective suture in the treatment of patients with high complex anal fistula is beneficial to the treatment effect of patients, reduces postoperative complications, and protects the anal function of patients, with good use value.
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Objective To evaluate the efficacy and safety of standardized seton therapy combined with the counterparts drainage improved surgical approach on the treatment of high anal fistula,and to form the technical specifications and application programs.Methods 120 patients of high anal fistula (simple and complex) from three centers were randomly divided into a treatment group and a control group,60 cases in each group.SPSS 16.0 was used to make a statistical analysis on actual enrolled patients,fall off and excluded patients.Demographics,distribution of cases and baseline data were also compared between the two groups to determine the efficacy and safety.The treatment group was treated with a modified hanging line with their counterpart drainage; while the control group was treated with traditional low cut high hanging line method.The length of healing time,hung off times,healing time,postoperative pain,anal and manometry were observed in both groups.Results Among 120 cases,118 eases were effective and 2 eases excluded off Healing time of the treatment group (29.87±3.93)d was less than the control group(35.32±8.61)d,P＜0.05.Hang off time of the treatment group (13.73±3.15)d was less than the control group (14.98±6.84) d,P＜0.05.Although the postoperative pain scores of the treatment group was lower than the control group,but with not statistical significance.Anal manometry was within the normal range,and anal function was not affected.Conclusion The quantitative hung up with the improved counterparts drainage surgical methods were safe and effective in the treatment of high anal fistula.