Clinical Study Of Anal Repair With Double "Λ"-shaped Sentinel Hemorrhoids Subdermal Vascular Network Flap For The Treatment Of Stage Ⅲ Anal Fissure

Objective:According to the clinical characteristics of typical sentinel hemorrhoids combined with anal fissure patients in phase III,the sentinel hemorrhoids were considered as a usable skin supply area to be fully utilized.The sentinel hemorrhoids were designed for anal repair with double "∧"-shaped subdermal vascular network skin flap.The clinical efficacy,operation time,intraoperative bleeding volume,wound healing time,postoperative pain index,postoperative complications,and patient satisfaction with postoperative anal appearance were observed and compared.The clinical effect of anal repair of double "∧"-shaped subdermal vascular network skin flap from the sentinel hemorrhoids was evaluated by specific data analysis.Methods:For 60 patients admitted to the Third People’s Hospital of Shouguang City from October 2016 to November 2017 who met the standards for stage III anal fissure,they were divided into treatment groups and control groups according to the random digital table method,each with 30 cases.The treatment group was treated with double “∧”-shaped subdermal vascular network skin flap from sentinel pile for anal restorations.The control group was treated with anal fissure resection and posterior internal sphincterotomy.The clinical efficacy,operation time,intraoperative hemorrhage,wound healing time,postoperative pain index on1,3,5,and 7days were analyzed and compared,and the relevant data were statistically processed.After 3 months of follow-up,the postoperative complications and the satisfaction of the patients with anal appearance were analyzed and compared,and the relevant data were statistically processed.Results:(1)Healing rate: The treatment group cured 29 cases,improved 1 case.The control group cured 27 cases,improved 3 cases.The total postoperative efficiency of the two groups of patients was 100%.There was no significant difference between the two groups after statistical treatment(p﹥0.05).(2)Operation time: The treatment group had the longest operating time of 43 min,the shortest was 32 min,and the median was 35 min.;The control group had the longest operating time of 22 min,the shortest was 15 min,and the median was 17 min.There were significant differences between the two groups after statistical treatment(p﹤0.05).(3)Number of intraoperative bleeding: The largest amount of bleeding in the treatment group was 45 ml,the smallest was 33 ml,and the median was 38 ml.The largest amount of bleeding in the control group was 45 ml,the smallest was 30 ml,and the median was 38 ml.There was no significant difference in the amount of bleeding between the two groups after statistical treatment(p﹥0.05).(4)The time of wound healing: The longest healing time in the treatment group was 9d,the shortest was 7d,and the median was 7d.The control group had the longest healing time of 22 d,the shortest was 16 d,and the median was 19 d.There were significant differences in healing time between the two groups after statistical treatment(p﹤0.05).(5)Postoperative wound pain index: The pain degree of the wound was reduced with time in 2 groups,but the pain index of the first,third,fifth and seventh days after the treatment group was better than that of the control group(p﹤0.05).(6)Postoperative complications: The incidence of postoperative complications in the treatment group was urinary retention(13.3%),postoperative hemorrhage(3.3%),anal stenosis(0.0%),and anal incontinence(0.0%),respectively.The incidence of postoperative complications in the control group was urinary retention(40.0%),postoperative hemorrhage(26.7%),anal stenosis(20.0%),and anal incontinence(20.0%).There were significant differences in the incidence of postoperative complications between the two groups after statistical treatment(p﹤0.05).(7)Appearance of anal surgery: By collecting pre-operative,post-operative and post-healing anal appearance images of patients with stage III anal fissure,the patient evaluated the postoperative and post-healing anal appearance and conducted a satisfaction survey of the patients.The results showed that: The satisfaction of the treatment group(100%)was higher than that of the control group(83.4%),and there was significant difference between the two groups(p﹤0.05).Conclusion:The treatment of anal fissure in stage Ⅲ with double "∧"-shaped subdermal vascular network skin flap from sentinel hemorrhoids for anal restorations was effective.By improving on the basis of traditional surgery,the treatment of anal fissure not only solves the problem of removing the syndromes,but also maintains the appearance of the anus,protects the anal function.It has the advantages of small wound,poor postoperative pain,short healing time,and less postoperative complications.It satisfies the patient’s aesthetic needs,and the patient’s compliance is strong and worthy of clinical application.