| Objective:Through the dynamic observation of the changes of the posterior anorectal angle before traditional solid thread-ligating therapy in patients with high anal fistula by imaging technology,a new hypothesis for hanging line therapy was put forward,which confirmed that the slow cutting and suture stimulating tissue can promote the secondary formation of the anorectal angle to prevent anal incontinence.Research methods:Thirty-seven cases of patients with high posterior horseshoe anal fistula who met the inclusion criteria admitted to Nan Jing Hospital of Traditional Chinese Medicine,from April 2020 to February 2021 were selected to conduct self-control before and after treatment according to the principles of recognized,effective,safe and comparable.The surgical treatment involved in this study was traditional solid thread-ligating therapy,and the postoperative suture tightening scheme was unified,and non-blind design was adopted.Record and compare the anorectal angle measured at rest,squeezing,and straining on defecography radiographs before and after the removal of rubber band,record and compare the patients before the operation and the wounds healed completely after 2 weeks of anorectal pressure and Wexner score,in the evaluation of anal function in patients with,in 2 weeks after patients healed completely overall efficacy assessment in the postoperative period.SPSS 22.0 statistical software was used to analyze the anal right Angle,anorectal pressure measurement and Wexner score of patients at different time before and after surgery.Through analysis and comparison of the data,it was confirmed that the stimulation of retraction thread could prevent anal incontinence by promoting the reduction of anal right Angle.Result:A total of 37 subjects were included in this study and all of them were completed.1.Comprehensive efficacy:the cure rate was 97.3%,the significant efficiency was 3.7%,and there was no recurrence after 3 months of postoperative follow-up.2.Anal right Angle size:(1)Anal right Angle of resting phase was 112.3 8± 12.61° on average before surgery,and 103.16±11.15° after the rubber band fell off,which was lower than that before surgery,and the difference was significant(P<0.01).(2)The anal right Angle of the lifting anal phase was 106.68±10.94° on average before surgery,and 100.03± 12.02° after the rubber band fell off,which was lower than that before surgery,and the difference was significant(P<0.05).(3)The anal right Angle of force displacement was 112.95± 11.15° before operation and 108.73± 12.56°after the rubber band fell off,which decreased after operation compared with before operation,but there was no statistical significance between the two(P>0.05).3.Anal function assessment:(1)Anorectal pressure measurement:due to economic,time and other factors,only 17 patients underwent pressure measurement before and after surgery.The average resting blood pressure of patients before surgery was 52.81 ± 12.30mmHg,and 2 weeks after healing was 46.38±16.21mmHg,which decreased after surgery compared with before surgery,and there was no statistical significance before and after surgery(P>0.05).The average maximum systolic blood pressure of the patients was 103.561 33.85mmHg before surgery,and 90.81 ± 34.10mmHg after surgery,which was lower than that before surgery,and the comparison before and after surgery was statistically significant(P<0.05).(2)Wexner score:The average Wexner score of patients was 1.32± 1.99 before surgery and 0.51 ±0.91 2 weeks after healing,which was not statistically significant(P>0.05).4.Pain score:3.68±1.99 on the 1st day after surgery,4.38±2.03 on the 1st day after the first tightness,1.32±1.06 on the 1st day after the rubber band fell off,and the difference was statistically significant in ANOV(P<0.01).Through multiple comparisons,it was found that there was no statistical significance between the first day after the operation and the first day after the first tightness(P>0.05),while there was significant statistical significance between the first day after the operation and the first day after the fall of the rubber band and the first day after the first tightness(P<0.0001).Conclusion:In patients with high anal fistula,the anorectal angle decreased after incision and suture,which confirmed that the stimulation of suture can promote the anal right Angle decreased to prevent anal incontinence. |
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