The Applied Study On Unidirectional Controlled Cutting Seton Treatment Of High Anal Fistula

[Background] High anorectal fistula surgery is common and difficult diseases.Because anal fistula through the external anal sphincter deep,therefore,when performing anal fistula incision needs to cut off part of the sphincter in order to achieve adequate drainage leaving fistula healing purposes.Although the use of cutting seton treatment can protect anal function,but different degrees of incontinence patients of about30%-50%.At present,the treatment of high anal fistula still is surgery,many therapeutic methods such as incision and thread,drag line drainage,drainage catheter,the bio-port patch repair and so on.Overall efficacy is acceptable,but there are still a long healing time after surgery,great pain suffering high recurrence rate and the large area defects cause anal dysfunction caused by varying degrees of incontinence problems and other complications.Thus by domestic and foreign experts as intractable fistula.In order to protect the high anal fistula resection and anal function to achieve better level.According to the method of the Ming Dynasty"ancient and modern medicine" recorded in the treatment of anal fistula Seton,"With grass on the ground in a hole,lead the parenteral,pendant plumb,quick-acting. Medicine line,intestinal muscle with long,out-of-the-way place,both water flow line by line,not wear sore hole, goose tube." It is the "One-way cutting" and "cutting force can be controlled" theory. We have designed a unidirectional controlled cutting seton surgery,in order to achieve the maximum protection to improve the quality of life in patients with anal function and form[Objectives] Cutting seton treatment of high anal fistula is bound to cause injury,may cause different degrees of anal function injury,severe cases can cause anal incontinence,affect the postoperative quality of life of patients.This topic through the application of traditional Chinese medicine tradition "one-way cutting and control cutting force" theory solve in the process of cutting force and cutting in the direction of the control,thus reducing the anus injury,better protection of anorectal ring integrity,reduce the postoperative anal incontinence and anus department "keyhole deformities" and other complications,improve patient quality of life.[Method] Through the two aspects of experimental study and clinical study,discussing unidirectional controlled seton method in treatment of high anal fistula the value and mechanism of reducing damge to the ans.Choosing12pigs to experimental study,seting up the anal fistula models,and unidirectional controlled seton method in treatment of high anal fistula,optimizating design of it,study the law of the biomechanics of the anal sphincter after surgey.Choose40cases of high anal fistula, divided into unidirectional controlled cutting seton group and traditional cutting seton group,20cases in each group.Postoperative observation compared the total efficacy of two groups of cases,pain index,off-line time,wound healing time,anus defect area,anus function evaluation index and postoperative recurrence rate.[Results] Unidirectional controlled cutting seton group compared with traditional cutting seton group, age, gender,total efficacy,pain index has no significant statistical difference (P>0.05).Two groups of postoperative such off-line time,wound healing time,anus defect area, anal canal pressure measurement,the anus incontinence score (Wexner score) and postoperative recurrence rate had significant difference (P<0.05).[Conclusion] Unidirectional controlled cutting seton surgery treatment of high anal fistula efficacy,have low recurrence rate,the anus small defect area and low rate of anal incontinence advantage.