【摘要】 目的：评价多切口拖管联合激光消融闭合术治疗高位马蹄型肛瘘的疗效及安全性。方法：纳入64例高位马蹄型肛瘘患者，随机分成治疗组和对照组，每组各32例。治疗组患者采用多切口拖管联合激光消融闭合术治疗，对照组患者采用切开挂线术治疗。比较两组患者的创面愈合时间及临床疗效；术后第2、7、14天，评价两组患者的疼痛、渗液情况；记录两组患者的术后并发症发生情况；术前及术后3个月，比较两组患者的Wexner肛门失禁评分，检测两组患者的肛管最大收缩压（AMCP）及肛管静息压（ASRP）。结果：(1)治疗组患者的创面愈合时间较对照组明显缩短（P<0.01）。(2)术后3个月，治疗组患者的临床总有效率为96.9%，对照组为93.8%，两组临床疗效比较差异无统计学意义（P>0.05）。(3)术后第2、7天，治疗组患者的疼痛、渗液评分较对照组均降低（P<0.05）。(4)治疗组患者的术后并发症发生率为6.25%，对照组为18.75%，治疗组患者的术后并发症发生率低于对照组（P<0.05）。(5)术后3个月，对照组患者的Wexner肛门失禁评分较术前明显升高（P<0.05），且高于治疗组（P<0.05）。(6)术后3个月，对照组患者的AMCP、ASRP水平较术前均明显降低（P<0.05），且对照组患者的AMCP水平低于治疗组（P<0.05）。结论：与传统切开挂线术相比，多切口拖管联合激光消融闭合术能够明显缩短高位马蹄型肛瘘患者的术后创面愈合时间，减轻术后疼痛、渗液等症状，减少术后并发症，降低术后肛门失禁的风险，安全性较高。更多还原

【Abstract】 Objective: To evaluate the efficacy and safety of tube-dragging therapy with multiple incisions combined with laser ablation closure in the treatment of high horseshoe anal fistula. Methods: A total of 64 patients with high horseshoe anal fistula were included and randomly divided into the treatment group and control group, 32 cases in each group. The patients in the treatment group were treated with tube-dragging therapy with multiple incisions combined with laser ablation closure, and the patients in the control group were treated with incision and thread-drawing therapy. The wound healing time and clinical efficacy were compared between the two groups. The pain and exudation of the two groups were evaluated on the 2nd,7th and 14th days after surgery. The postoperative complications of the two groups were recorded. Before surgery and 3 months after surgery, the Wexner incontinence score was compared between the two groups, and the anal maximal contraction pressure(AMCP) and anal sphincter resting pressure(ASRP) of the two groups were detected. Results:(1)The wound healing time of the treatment group was significantly shorter than that of the control group(P<0.01).(2)Three months after surgery, the total clinical effective rate was 96.9% in the treatment group and 93.8% in the control group, with no statistically significant difference between the two groups(P>0.05).(3)On the 2nd and 7th days after surgery, the pain and exudation scores of the treatment group were decreased compared with the control group(P<0.05).(4)The incidence of postoperative complications was 6.25% in the treatment group and 18.75% in the control group. The incidence of postoperative complications in the treatment group was lower than that in the control group(P<0.05).(5)Three months after surgery, the Wexner incontinence score of the control group was significantly increased compared with that before surgery(P<0.05), and was higher than that of the treatment group(P<0.05).(6)Three months after surgery, the levels of AMCP and ASRP in the control group were significantly decreased compared with those before surgery(P<0.05), and the level of AMCP in the control group was lower than that in the treatment group(P<0.05). Conclusion: Compared with the traditional incision and thread-drawing therapy, tube-dragging therapy with multiple incisions combined with laser ablation closure can significantly shorten the postoperative wound healing time of patients with high horseshoe anal fistula, reduce the postoperative pain and exudation symptoms, reduce the postoperative complications, and decrease the risk of postoperative anal incontinence, with high safety.更多还原