Clinical Study On The Standardization Of The Technical Parameters Of Traditional Chinese Medicine Cutting Seton Therapy For High Anal Fistula

High anal fistula is stubborn disease. According to the medical literature, cutting seton therapy of traditional Chinese medicine has been the mainstream treatment method in the domestic medical circle for high anal fistula. But there is a lack of unitive standardied programme of cutting seton therapy to easy to operate.In order to quantify the cutting seton programme, we has designed a elastic loop with scales for tightening appropriately the muscle.The thesis is divided into two parts:PartⅠ:Documental summary.1,The systemic summary of the diagnostic method and cure therapy of anus fistula.2,The systemic summary of the surgical therapy of high anus fistula.3,The systemic summary of seton therapy for high anus fistula.PartⅡ:Clinical reseachObjective:To study on the standardization of seton therapy which has advantages of traditional Chinese medicine. And to achieve the quantized process of operating cutting seton. The aim of the study is make the seton therapy easy to operate and popularized, so that the clinical curative powers of high anal fistula would be improved and the incidence of incontinence would be reducedMethods:45 examples who were diagnosed as high anal fistula definitely had been studied, divided into three groups stochastically. There were 37 male and 8 female patients, with a median age of 34 years. Every group had 15 examples and adopt the traditional low-position incision and high-position cutting seton therapy in all cases. The difference between the three groups was seton tightness degree. The experimental group one:when hang up the seton on muscle tissues, tighten the seton 1/4 of the tissues'girth. The experimental group two:tighten the seton 1/3 of the tissues'girth. experimental group three:tighten the seton 1/2 of the tissues'girth. And then the total curative effect analyzed by two-month recrudescence situation wound healing time,manometry for function of the anal sphincter the area of the postoperative wound and postoperative pain of three groups.Results:Cure rate of there groups were all 100%. Three groups in the aspect of the total curative effect,two-month recrudescence situation had no significant difference (P> 0.05). (1) Postoperative anal pressure were all decline, anal rest pressure decreased more significantly than anal squeeze and anal press pressure. The postoperative anal rest pressures decreased 1/6 original anal rest pressures in the experimental group one, and decreased 1/4 in the experimental group two, and decreased 1/3 in the experimental group three, they had significance difference (P<0.05).1 score of Wexner scores was the highest score in there groups. The patients get 1 score couldn't control the gas or need pads once a while. (2) As to VAS score of the first day after operation, the difference between the three group is 1 score, compared between any two groups. (3) The mean duration with the seton in place was 18.00±0.557 days in experimental group one, and 13.73±0.228 days in experimental group two,10.27±0.777days in experimental group three。(4) The mean time of the wound healing was 34.13±0.89 days in experimental group one, and 28.54±0.88 days in experimental group two,30.73±0.89 days in experimental group three, which had significance difference compared between any two groups (P<0.05).Conclusion:The patients had the lightest pain, the lowest effect on function of the anal sphincter, but the longest wound healing time in the experimental group one; the patients had moderate pain, comparatively less effect on function of the anal sphincter, and the shortest wound healing time in the experimental group two; the patients had the heaviest pain, the more comparatively significant effect on function of the anal sphincter, and medium wound healing time in the experimental group three. So, we can draw the conclusion that tightening the seton 1/4 or 1/3 of the tissues'girth were better operative methods, which could less effect on function of the anal sphincter, and decrease recurrence rate. The elastic loop with scales we designed was easy to use, which ensure the safety of the difficult surgery. Using the elastic loop with scales as a seton with repeated tightening at weekly intervals was safe and effective. The methods of tightening the seton 1/4 or 1/3 of the tissues'girth would give shorter duration of wound recovery, low recurrence and less continence disorders. These methods and elastic loop with scales are worth spreading for the clinical practice.