肛瘘保留括约肌手术最新研究进展

<正>肛瘘不能自愈,需要医疗干预,手术是治疗肛瘘最重要的手段。治疗肛瘘的手术有很多,各有其优缺点,但大致可由2大类组成：(1)传统及其改良术式（瘘管切开术、切开挂线术等）;(2)肛门括约肌保留术式（sphincter saving techniques,SST）,含括约肌间瘘管结扎术（ligation of intersphincteric fistula tract,LIFT）、经肛门直肠黏膜瓣推移术（endoanal advancement flap,ERAF）、保留外括约肌的瘘管切开术（external sphincter-sparing anal fistulotomy,     

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。     

复杂性肛瘘保留括约肌手术的治疗进展

目前复杂性肛瘘的治疗普遍存在复发率高、肛门功能保护不足的现状.传统的肛瘘切开术和切割挂线术损伤肛门括约肌,易致肛门失禁,已逐渐被保留括约肌术式,如推移瓣、肛瘘栓、经括约肌间瘘管结扎术等所取代.本文将对复杂性肛瘘保留括约肌手术治疗进展作一综述.     

探析肛瘘及肛周脓肿合并糖尿病手术治疗可行性

目的探析肛瘘及肛周脓肿合并糖尿病手术治疗可行性。方法该次研究资料选自2012年2月—2014年8月期间在该院接受诊断及治疗的28例肛瘘及肛周脓肿合并糖尿病病人,随机划分成两个小组。其中,实验组14例病人接受针对性手术治疗,而对照组14例病人接受常规手术治疗,对比及分析两组研究对象的治疗情况。结果两组研究对象在治疗效果、创口渗液总时长以及创口愈合时间等临床指标之间的差异有统计学意义(P0.05)。结论肛瘘及肛周脓肿合并糖尿病手术治疗体现出显著可行性,建议推广。     

肛瘘的围手术期处理

肛瘘是临床上常见的肛门疾病之一，手术仍是最主要的治疗方法，手术方式包括挂线术、瘘管切开术和瘘管切除术等，但手术后复发是影响疗效的主要原因。唐卫中等报道肛瘘切除术后的复发率为3．15％。我们自1992～2002年手术治疗低位、高位、单纯性、复杂性肛瘘共1635例，术后复发54例，复发率为3．3％。对以上病例进行回顾性分析发现，引起肛瘘术后复发的原因主要是围手术期处理欠妥，     

微创手术治疗拇外翻畸形的疗效分析

目的:探讨微创手术治疗拇外翻畸形的效果.方法:选择2018年1月～2019年1月间我科收治的24例拇外翻畸形患者,根据手术方式不同将患者分为2组各12例,观察组采用微创手术,对照组采用传统开放性手术,比较两组手术效果.结果:观察组患者手术优良率为91.67％,显著高于对照组66.67％(P<0.05);观察组手术后AO...     

大隐静脉曲张治疗的研究进展

单纯性下肢浅静脉曲张系指病变范围仅限于下肢浅静脉者,其中以大隐静脉最为多见。对于大隐静脉曲张的治疗,传统的大隐静脉高位结扎剥脱术长久以来一直是其主要治疗方式,但随着医学水平的不断发展,先后有一些新的手术方法相继问世并极大地提高了下肢静脉曲张的手术疗效。该文对其治疗的研究进展作一综述。     

间充质干细胞治疗克罗恩病肛瘘研究进展

克罗恩病(Crohn’s disease, CD)是一种累及全消化道的跳跃性全层炎症性肠病,肛瘘是CD常见的临床表现之一,临床发病率可达28%～43%。CD肛瘘的治疗需要结合患者的实际情况选择个体化的治疗方案,包括合适的药物种类和手术方法,目前并没有高成功率的金标准治疗方案,临床复发率较高。间充质干细胞(mesenchymal stem cell, MSC)是一种多能干细胞,具有自我更新和分化为多种类型细胞的能力,被广泛应用于再生医学领域,MSC疗法对于CD患者是一种富有前景的新选择。与传统治疗手段相比,MSC在诱导和维持瘘管闭合方面表现出更高的效率,具有很强的免疫调节作用和微创性,特别是对于瘘管复杂、常规治疗不耐受的患者。本文结合国内外最新研究报道,就MSC治疗CD肛瘘的研究进展进行综述。     

影像学检查在肛瘘诊治中的研究进展

肛瘘是肛管或直肠下段同肛门周围皮肤之间或临近组织、器官之间,因病理性原因形成的不正常的通道,是外科的常见病、多发病。随着影像学的发展,肛门腔内彩超(EAUS)和MRI检查已能够对肛瘘的术前治疗策略产生很大影响,可以指导医生选择合适的手术方法以缩短愈合时间、减少复发。现     

Skin grafts in surgery for anal fistula

Conclusion Sometimes skin grafts are indicated in surgery for anal fistulas as a delayed procedure when a large wound has become flat. Even then, they have certain disadvantages and are not always successful. Read at the combined meeting of the Mexican and American Proctologic Societies, Acapulco, Mexico, April 20 to 23, 1967.     

Initial experience of treating anal fistula with the Surgisis anal fistula plug

Background

Complex anal fistulas remain a challenge for the colorectal surgeon. The anal fistula plug has been developed as a simple treatment for fistula-in-ano. We present and evaluate our experience with the Surgisis anal fistula plug from two centres.

Methods

Data were prospectively collected and analysed from consecutive patients undergoing insertion of a fistula plug between January 2007 and October 2009. Fistula plugs were inserted according to a standard protocol. Data collected included patient demographics, fistula characteristics and postoperative outcome.

Results

Forty-four patients underwent insertion of 62 plugs (27 males, mean age 45.6?years), 25 of whom had prior fistula surgery. Mean follow-up was 10.5?months Twenty-two patients (50%) had successful healing following the insertion of plug with an overall success rate of 23 out of 62 plugs inserted (35%). Nineteen out of 29 patients healed following first-time plug placement, whereas repeated plug placement was successful in 3 out of 15 patients (20%; p?=?0.0097). There was a statistically significant difference in the healing rate between patients who had one or less operations prior to plug insertion (i.e. simple fistulas) compared with patients who needed multiple operations (18 out of 24 patients vs. 4 out of 20 patients; p?=?0.0007).

Conclusions

Success of treatment with the Surgisis anal fistula plug relies on the eradication of sepsis prior to plug placement. Plugs inserted into simple tracts have a higher success rate, and recurrent insertion of plugs following previous plug failure is less likely to be successful. We suggest the fistula plug should remain a first-line treatment for primary surgery and simple tracts.     

Change in anal continence after surgery for intersphincteral anal fistula: a functional and manometric study

BACKGROUND AND AIMS: Dividing or "laying open" of the tract for intersphincteral type anal fistula is simple and effective and entails low risk of complication, but little is known of the functional and manometric results. This study assessed the clinical and manometric effect of this surgery on anal sphincter function. PATIENTS AND METHODS: The study examined 45 adults undergoing surgical treatment for intersphincteral fistula. We administered the questionnaire for continence score and performed anorectal manometry before the operation and at least 6 months after the operation. The operative method was laying open of the fistula tract and trimming the redundant anoderm for adequate drainage of the wound in all cases. RESULTS: There was a significant decrease in maximal resting anal pressure and in resting pressure throughout the distal 2 cm of the anal canal after operation. The maximal contractile pressure after operation was similar to that before operation. Continence control was significantly poorer in women and patients who had lower preoperative resting pressure. Multivariate analysis showed lower preoperative resting pressure to be the only independent factor for impaired continence control after fistula surgery. CONCLUSION: Although laying open of the fistula tract is a simple and effective therapy for intersphincteral type anal fistula, it should be more conservative for patients with low resting anal pressure.     

Quadruple anal fistula:

Usually an anal fistula has an internal (primary) opening, an external (secondary) opening, and a tract connecting the two. Uncommonly the external openings are more than one but lead to a single internal opening. Rarely more than one internal opening is present, and, along with its corresponding external opening(s), it should be considered as a separate fistula. Injection of a dye to identify the internal opening may be considered when may external openings are present.     

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.