肛瘘经括约肌行括约肌间瘘管改良结扎术的临床疗效研究

目的研究经括约肌间瘘管改良结扎术对于经括约肌肛瘘的临床疗效。方法我院2011年7月~2013年7月收治的100例经括约肌肛瘘患者,随机分为观察组、对照组各50例;观察组采用经括约肌间瘘管改良结扎术,对照组采用传统手术方法-开放瘘管切割挂线术。比较两组治疗情况。结果观察组治疗总有效率高于对照组,复发率、手术时间、住院时间及创面愈合时间低于对照组(P<0.05);两组术后,观察组肛门功能评分、并发症发生情况显著优于对照组(P<0.05)。结论经括约肌间瘘管改良结扎术与传统手术方式相比各项指标均明显改善,对于肛瘘的治疗具有良好的临床疗效。     

经括约肌间瘘管结扎术联合负压封闭引流治疗复杂性肛瘘疗效观察

目的 观察经括约肌间瘘管结扎术（LIFT）与负压封闭引流（VSD）联合治疗复杂性肛瘘的临床疗效。方法 80例复杂性肛瘘患者随机分为联合组和传统组各40例,传统组行切开肛瘘挂线旷置术,联合组行LIFT与VSD联合术,术后随访6个月。两组术后创口愈合时间、术后并发症、住院费用。结果 联合组与传统组创口愈合时间短传统组,治愈率高于传统组,住院费用低于传统组,P均〈0.05;联合术出现术后并发症传统组2例患者出现肛门漏气但无溢液。结论 LIFT联合VSD治疗复杂性肛瘘疗效较好,术后创口愈合时间短,并发症较少。     

括约肌间瘘管结扎术治疗复杂性肛瘘

括约肌间瘘管结扎术(ligation of intershpincteric fistula tract,LIFT)是治疗复杂性肛瘘,特别是经括约肌肛瘘的新术式.2007年由泰国医生Rojanasakul首次提出,其优势在于早期治愈率高,且肛门失禁率为零,而且完全保留括约肌.近几年来,LIFT手术的临床研究表明其疗效差异较大.本文试对LIFT手术的临床研究现状作一综述.     

Oddi括约肌功能与经内镜乳头括约肌切开术后远期 并发症的关系

胆总管结石是临床常见病,经内镜逆行胰胆管造影术(ERCP)联合经内镜乳头括约肌切开术(EST)是临床首选的治疗方法。然而其术后远期并发症发生率仍然很高,目前较公认的机制是EST术中破坏了Oddi括约肌结构,引发功能障碍,导致肠胆反流,进而出现术后远期并发症。本文就Oddi括约肌功能与EST术后远期并发症的关系及研究现状做如下综述。     

瘘管内口切开术治疗低位肛瘘（附40例报告）

目的观察瘘管内口切开术治疗低位肛瘘的疗效。方法将70例低位肛瘘患者随机分为A组（40例）和B组（30例）。A组行瘘管内口切开术，B组行传统瘘管切开术。比较两组手术疗效及术后肛门功能。结果A、B组治愈率均为100％（P〉0．05），术后肛门功能正常者分别为100％和83．3％（P〈0．05）。结论瘘管内口切开术治疗低位肛瘘疗效好，组织损伤轻，能更好地保护肛门功能。     

经内镜括约肌切开术与球囊扩张治疗胆总管结石的比较

经内镜括约肌切开术（endoscopic sphincterotomy，EST）已广泛应用于治疗胆总管结石患者，具有很好的疗效，但其有出血、后腹膜穿孔、化脓性胆管炎及急性胰腺炎等并发症，死亡率达0．2％～1．5％。近几年开展的乳头球囊扩张术（endoscopic balloon dilation，EPBD）具有创伤小，操作简单、安全，并能部分保留Oddi括约肌功能等特点，但也有学者认为EPBD术后有急性胰腺炎的并发症增多、住院日延长等缺陷。我院2001年2月至2004年11月期问用EST及EPBD治疗282例胆总管结石患者，大部分患者随访2年：     

经内镜乳头括约肌切开术远期并发症的研究进展

经内镜乳头括约肌切开术(endoscopic sphincterotomy,EST)开展已有30年,适应证较广,我国也已普遍应用于临床。EST其短期并发症已为大家所熟知,如胰腺炎、出血、穿孔、感染,经适当治疗,大多能痊愈。现在远期胆道并发症如结石的复发、乳头狭窄等已引起了很多学者的高度重视。现将EST远期并发症的有关研究综述如下。     

核素显像和胆道造影观察经内镜乳头括约肌切开术前后胆道机能形态的变化

目的探讨经内镜乳头括约肌切开术（ＥＳＴ）对胆道机能形态的影响。方法应用肝胆动态显像和胆道造影,分别比较８例ＥＳＴ前后胆管胆汁排出及胆总管直径改变情况。结果肝胆动态显像各指标ＥＳＴ前后有明显改善。胆道造影表明ＥＳＴ前后胆总管直径有明显改变。结论ＥＳＴ明显改善胆汁流出,解除胆道梗阻,使扩张胆管回缩。     

经内镜括约肌切开术与经内镜乳头球囊扩张术在胆石症治疗中的应用

近30年来,内镜技术发展迅速,尤其在胆胰疾病的诊断和治疗方面日益发挥着重要作用。对胆管结石而言,内镜下取石术基本上已经取代了传统的剖腹手术,经内镜括约肌切开术(endoscopic sphincterotomy,EST)和经内镜乳头球囊扩张术(endoscopic papillary balloon dilatation,EPBD)已成     

经肛门三点式直肠粘膜组合结扎加肛门紧缩术治疗直肠脱垂

为探索手术治疗成人直肠全层脱垂途径 ,针对直肠脱垂的发病特点 ,我们设计了经肛门三点式直肠粘膜组合结扎加肛门紧缩术 ,经临床实践证明效果满意 ,现报告如下。临床资料 :本组直肠脱垂患者 2 15例 ,男 188例、女性 2 7例 ,年龄以 16～ 30岁最多 ,病程 1～ 5 0年。主要表现为大便时直肠全层脱出肛门 ,其中合并粘液血便 48例、腹泻 10例、肛门部坠胀 75例、肛门不完全性失禁 1例。伴神经衰弱 14例 ,胃炎、胃溃疡 2 2例 ,子宫脱垂 2例 ,高血压、心肌梗死 3例 ,其它肛门病患者 15例。发病原因为腹泻、痢疾后发病者 6 7例 ,幼年病后 15例 ,便秘 …     

Modern management of anal fistula

Ideal surgical treatment for anal fistula should aim to eradicate sepsis and promote healing of the tract,whilst preserving the sphincters and the mechanism of continence.For the simple and most distal fistulae,conventional surgical options such as laying open of the fistula tract seem to be relatively safe and therefore,well accepted in clinical practise.However,for the more complex fistulae where a significant proportion of the anal sphincter is involved,great concern remains about damaging the sphincter and subsequent poor functional outcome,which is quite inevitable following conventional surgical treatment.For this reason,over the last twodecades,many sphincter-preserving procedures for the treatment of anal fistula have been introduced with the common goal of minimising the injury to the anal sphincters and preserving optimal function.Among them,the ligation of intersphincteric fistula tract procedure appears to be safe and effective and may be routinely considered for complex anal fistula.Another technique,the anal fistula plug,derived from porcine small intestinal submucosa,is safe but modestly effective in long-term follow-up,with success rates varying from 24%-88%.The failure rate may be due to its extrusion from the fistula tract.To obviate that,a new designed plug(GORE BioA ) was introduced,but long term data regarding its efficacy are scant.Fibrin glue showed poor and variable healing rate(14%-74%).Fi La C and video-assisted anal fistula treatment procedures,respectively using laser and electrode energy,are expensive and yet to be thoroughly assessed in clinical practise.Recently,a therapy using autologous adiposederived stem cells has been described.Their properties of regenerating tissues and suppressing inflammatory response must be better investigated on anal fistulae,and studies remain in progress.The aim of this present article is to review the pertinent literature,describing the advantages and limitations of new sphincterpreserving techniques.     

Mucosal advancement in the treatment of anal fistula

One hundred eighty-nine patients with anal fistula treated within an eight-month to seven-year period by anal fistulectomy and rectal mucosal advancement are presented. An 80 percent follow-up revealed a 90 percent asymptomatic group and a ten percent group who had minor symptoms. Eight percent of the symptomatic patients had minor soiling; 7 percent were incontinent for gas, and 6 percent were incontinent for loose stools. No patient was incontinent for solid feces. There was a 1.5 percent rate of recurrent anal fistula comparable to other techniques.     

肛瘘微创平台用于治疗高位复杂性肛瘘的临床研究

目的观察肛瘘微创平台用于治疗高位复杂性肛瘘的效果,评价其临床疗效性及安全性。 方法选取2016年10月至2018年5月在南京市中医院肛肠中心就诊且符合高位复杂性肛瘘诊断标准的106名患者,利用随机数字表将患者随机分为观察组和对照组,其中观察组采用肛瘘微创平台治疗,对照组采用传统低位切开高位挂线术进行手术治疗,术后采取电话或网络随访4~30（中位数10）个月。 结果两组治愈率及安全性评价差异无统计学意义（χ²=2.37,P>0.05）,观察组及对照组愈合时间分别为（38.61±7.15）天和（51.72±9.25）天,差异有统计学意义（t=-8.02,P<0.01）。观察组术后肛管静息压及最大收缩压均大于对照组（t=5.71,7.83;P<0.05）,Wexner评分优于对照组（t=-4.40,P<0.05）。 结论肛瘘微创平台治疗高位复杂性肛瘘疗效确切,安全可靠。     

Efficacy and safety of ligation of intersphincteric fistula tract in the treatment of anal fistula: A protocol for systematic review and meta-analysis

Background:Anal fistula is characterized with perianal cellulitis, anorectal pain, smelly or bloody drainage of pus, and difficulty in controlling bowel movements. Ligation of intersphincteric fistula tract (LIFT) technique is a recently developed approach against anal fistula, and it could alleviate the pain of the patient, with little postoperative trauma, which can greatly shorten the wound healing time and hospitalization stay. We conduct the meta-analysis and systematic review to systematically evaluate the clinical efficacy and safety of LIFT in the treatment of anal fistula.Methods:Randomized controlled trials of LIFT against anal fistula will be searched in several Chinese and English databases. Two reviewers will independently conduct the literature extraction and risk of bias assessment. Statistical analysis will be conducted in RevMan 5.3.Results and conclusions:The study will help to systematically evaluate the clinical efficacy and safety of LIFT in the treatment of anal fistula.OSF Registration number:DOI 10.17605/OSF.IO/T4FUH     

Treatment of transsphincteric anal fistulas by the seton technique

Twenty-one patients with high transsphincteric fistulas treated by the seton technique were re-examined after two to 14 years. None had recurrent fistulas, but 13 (62 percent) had some degree of continence disturbances. All patients with anal deformities had continence disorders.     

Clinical and manometric results of endorectal advancement flaps for complex anal fistula

Backgrounds and aim Endorectal advancement flap repair is a well-recognized method for the treatment of complex anorectal fistula. The purpose of this study was to prospectively assess the clinical and functional results of endorectal advancement flaps for complex anorectal fistula and to identify factors that affect outcome. Materials and methods A prospective study of 56 patients was performed. Clinical and functional results were studied using the Wexner continence scale and anal manometry before and after surgery. Factors associated with recurrence and incontinence were analyzed by univariate and multivariate regression analysis. Results Sixty endorectal flaps were constructed in 56 patients. Mean age was 49 years (range 24–74). The fistula was of cryptoglandular origin in 91.1% cases. Mean follow-up was 43.8 months. The technique was repeated in four patients because of recurrence (7.1%), with subsequent healing in all cases. There were significant reductions in maximum resting pressure 3 months after surgery (83.6±33.2 vs 45.6±18.3, p<0.001) and maximum squeeze pressure (208.8±91.5 vs 169.5±75, p<0.001). Before surgery, five patients (8.9%) reported incontinence symptoms. After surgery, 78.6% patients had normal continence, seven patients (12.5%) complained of minor incontinence, and five (9%) had major continence disturbances. None of the variables studied (age, sex, previous fistula surgery, rectovaginal fistula, and Crohn’s disease) affected the outcome of the procedure in multivariate analysis. Conclusions Endorectal advancement flap repair is an effective technique for complex anal fistula, with a low recurrence rate (7.1%). Patients (21.4%) reported disturbed anal continence. It is still not possible to identify factors that are predictive of failure or incontinence.     

肛瘘患者手术前后肛管直肠动力学研究

目的利用肛管直肠测压技术,评价和分析肛瘘患者手术前后肛管直肠功能的变化。方法用肛管直肠测压方法对20例正常对照者,67例肛瘘患者,22例多次手术后患者进行肛管长度、肛管静息压、肛管最大收缩压、直肠压、直肠黏膜感觉功能检测。分别将正常对照组与肛瘘组、对照组与经手术组、肛瘘组与经手术组进行比较,分析肛管直肠功能的变化。结果肛瘘患者肛管静息压力及最大收缩压力大于正常人群(P<0.05),手术组和肛瘘组比较,肛管功能长度变短(P<0.05),肛管静息压力及收缩压力降低(P<0.05),直肠黏膜敏感性增加(P<0.05),与正常对照组比较,差异有统计学意义(P<0.05)。结论肛管压力的增加可能是肛瘘产生的一个病因之一,肛瘘患者多次手术以后,可能会造成肛门括约肌的损伤,从而影响肛管功能,临床应将肛管直肠测压技术推广应用于肛瘘患者手术前后肛门功能的评估。     

改良TROPIS联合置管引流术治疗复杂性肛瘘的疗效及安全性研究

目的观察改良TROPIS联合置管引流术治疗复杂性肛瘘的疗效及安全性研究。 方法回顾性分析2019年4月~2020年10月在南京中医药大学附属南京中医院肛肠中心住院治疗的100例复杂性肛瘘（或伴脓肿）患者的临床资料,根据手术方式的不同,分为治疗组（采用改良TROPIS联合置管引流术,n=52）与对照组（采用切开挂线术,n=48）。比较两组手术时间、术中出血量、疼痛评分（术后第1、3、7天）、创面面积（手术当天、术后7天、术后14天）、创面愈合时间、肛门Wexner评分（术后3个月）、肛管静息压和肛管最大收缩压（术后3个月）、术后并发症、临床疗效及复发情况。 结果两组患者术后3个月的肛门Wexner评分、复发率比较差异均无统计学意义（均P＞0.05）。治疗组的手术时间更短（t=5.473,P＜0.05）,术中出血量更少（t=5.426,P＜0.05）,术后不同时点（第1、3、7天）的疼痛评分均低于对照组（t=5.873,6.665,2.162;P＜0.05）,不同时点的创面面积均小于对照组（t=40.744,40.154,42.535;P＜0.05）,创面愈合时间短于对照组（t=14.356,P＜0.05）,术后出现排尿不畅的并发症少于对照组（χ²=4.537,P＜0.05）,并发症的总发生率低于对照组（χ²=8.310,P＜0.05）,术后3个月的肛管静息压和肛管最大收缩压高于对照组（t=2.348,2.180;P＜0.05）,术后3个月的总有效率高于对照组（Z=4.947,P＜0.05）。 结论与切开挂线术相比,改良TROPIS联合置管引流术治疗复杂性肛瘘能缩短手术时间、减少术中出血、减轻术后肛门疼痛、缩短创面愈合时间、减少术后并发症,在保证疗效的情况下能更好地保护肛门功能。