外切内挂胶管引流术治疗高位肛瘘临床分析

目的观察外切内挂胶管引流术治疗高位肛瘘的效果。方法依据不同手术方法将90例高位肛瘘患者分为2组,各45例。对照组行外切挂线术,观察组行外切内挂胶管引流术。比较2组疗效。结果观察组术后第3、7天的VAS评分较对照组低,术后1个月肛门功能优于对照组,差异均有统计学意义(P0.05)。结论与外切挂线术比较,外切内挂胶管引流术治疗高位肛瘘术后疼痛较轻,对肛门功能损伤小,效果满意。     

改良经肛门括约肌间瘘管结扎术治疗高位肛瘘临床分析

目的评估改良经肛门括约肌间瘘管结扎术(改良LIFT)治疗高位肛瘘的临床疗效。方法回顾性分析浙江省人民医院2015年6月至2016年6月期间收治的经改良LIFT手术治疗的高位肛瘘患者30例的临床资料,分析患者的手术时间、创口愈合时间、术后疼痛程度、术后肛门功能及复发率等临床数据。结果经改良LIFT手术治疗的高位肛瘘患者手术时间为(37±3.3)分钟,术后疼痛程度均轻度,创口愈合时间23.2±3.3天,仅2例出现复发。结论高位肛瘘行改良LIFT具有术后疼痛轻,肛门功能良好,复发率低,值得临床推广。     

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目的 观察和评估瘘管隧道法切除一期缝合术治疗肛瘘的临床疗效。方法 将1994例肛瘘病人随机分成：瘘管隧道法切除一期缝合术组（TRFS组，68例），肛瘘切除缝合术组（FS组，64例）和肛瘘切除术组（F组，62例）。观察三组病例创面愈合时间，术后伤口感染情况，监测术后疤痕大小，肛门变形情况和肛门括约肌功能，，随访术后2年内的复发情况。结果 TRFS组和FS组术后创面愈合时间较F组明显缩短（P＜0．05），术后的疤痕小（P＜0．05），FS组术后伤口感染率和复发率较其它两组高（P＜0．05），TRFS组和FS组术后肛门变形的病例很少（P＜0．05），TRFS组和FS组术后均未出现肛门括约肌损伤引起大便失禁的病例。结论 瘘管隧道法切除一期缝合术既能达到根治肛瘘的目的，又最大限度地保护了肛门括约肌的功能，创面愈合时间短，术后疤痕小，手术复发率低，是治疗肛瘘的首选方法。     

切缝结扎引流术治疗肛瘘的临床观察

目的 :观察和评价切缝结扎引流术治疗肛瘘的临床疗效。方法 :将 137例肛瘘患者随机分成 A、B、C 3组 ,其中 A组 4 6例采用切缝结扎引流术 ,B组 4 6例采用切缝引流术 ,C组 4 5例采用切开引流术。观察 3组病例术后继发出血情况 ,术后伤口感染情况 ,创面愈合时间 ,术后疤痕大小 ,肛门功能受损和随访术后 1年内的复发情况。结果 :A组术后继发出血和术后伤口感染例数较其它两组低 ,A组和 B组术后创面愈合时间较 C组明显缩短 (P <0 .0 5 ) ,且术后疤痕小 (P <0 .0 5 )。结论 :切缝结扎引流术治疗肛瘘能有效地防止术后继发出血、伤口感染和肛门功能受损等并发症 ,并且创面愈合时间短 ,术后疤痕小 ,复发率低 ,是治疗肛瘘的首选术式。     

隧道式瘘管剔除结扎术治疗单纯性高位肛瘘的临床疗效观察

目的探讨应用隧道式瘘管剔除结扎术治疗单纯性高位肛瘘的临床疗效和安全性。方法前瞻性将2012年7月至2013年6月期间收治的符合纳入标准的180例单纯性高位肛瘘患者按随机序列表法分成两组,每组90例,分别行隧道式瘘管剔除结扎术(治疗组)和肛瘘切缝挂线引流术(对照组)。观察两组的根治率、复发率、术后肛门功能、术后疼痛、愈合时间。结果治疗组与对照组在根治率、复发率差异无统计学意义,两组在保护肛门功能、平均愈合时间、术后疼痛差异有统计学意义。结论隧道式瘘管剔除结扎术疗效好、疗程短、复发率低、对控便功能损伤小,是高位单纯性肛瘘治疗的可行选择。     

多入路框架式引流切口治疗高位复杂性肛瘘50例疗效观察

为探讨一种理想的治愈高位复杂性肛瘘的方法,采用多入路建立框架式引流切口治疗高位复杂性肛瘘50例,从创口愈合时间、术后肛门功能、复发率、疼。薯程度方面评价手术疗效。结果显示,本组50例患者均一次性治愈。38例患者疼痛视觉模拟评分（VAS）为4～5分,12例患者VAS为3～4分。住院时间为18-32d,平均23d。术后随访1年,均无复发,无肛门功能异常。结果表明,多入路建立框架式引流切口可一次性治愈高位复杂性肛瘘,且不损伤肛门功能,患者术后疼痛轻,住院时间短。     

置管引流联合负压吸引治疗高位复杂性肛瘘的临床效果研究

目的探讨置管引流联合负压吸引治疗高位复杂性肛瘘的临床效果。方法回顾性分析上海中医药大学附属龙华医院2015年7月至2018年6月采用置管引流联合负压吸引法治疗的43例高位复杂性肛瘘患者的治愈率、术后创面愈合时间、复发率及Williams肛门功能等级。结果 43例研究对象术后创面一期愈合率为72.09%(31/43),创面平均愈合时间(47.41±18.39) d。12例患者术后三个月仍未愈合行第二次手术治疗,其中7例愈合、5例好转,总体愈合率为88.37%(38/43)。术后随访6～36个月,创面愈合患者均无复发。术后Williams肛门功能评级A级40例、B级3例。结论高位复杂性肛瘘采用瘘管深部腔隙置管引流联合负压吸引治疗可有效清除深部感染灶,具有良好的临床治疗效果。     

内扎外切弧形缝合术治疗环状混合痔100例疗效分析

目的探讨内扎外切弧形缝合术治疗环状混合痔的l临床疗效。方法对100例环状混合痔患者施行内扎外切弧形缝合术,就术后愈合时间、肛缘水肿、肛门狭窄及术后复发率进行回顾性研究。结果100例均一次性治愈,切口愈合时间10～25d,平均14．7土5．3d,肛缘水肿发生率6％,无1例出现术后肛门狭窄,术后1年复发率5％。结论在治疗环状混合痔时,内扎外切弧形缝合术具有治愈率高、复发率低等优点,较好地解决了环状混合痔术后肛门狭窄、肛门水肿等并发症的发生。     

同期多侧挂线治疗高位复杂性肛瘘的临床对比观察

目的：探讨同期多侧挂线术治疗高位复杂性肛瘘的临床价值。方法：将90例高位复杂性肛瘘患者分为两组，治疗组50例。采用同期多侧挂线术。对照组40例，采用单侧分期挂线术。术后均随访0．5～4年，比较两组患者术后创面愈合时间及并发症情况。结果：两组在创面愈合时间及术后并发症差异具有显著性意义，治疗组创面愈合时间及术后并发症明显少于对照组，术后随访过程中，治疗组无复发、肛门失禁、肛门移位等后遗症。肛门功能正常。结论：同期多侧挂线术能明显缩短疗程，降低术后并发症的发生率，是治疗高位复杂性肛瘘合理、安全、有效的术式。     

肛门后正中切开术治疗后高位蹄铁型肛周脓肿及肛瘘50例

为探寻治疗后位高位蹄铁型肛周脓肿和肛瘘的有效手术方法,减少并发症,对38例后位高位蹄铁型肛周脓肿及12例后高位蹄铁型肛瘘患者采用肛门后正中切开手术治疗。结果显示,38例肛周脓肿和12例高位肛瘘全部治愈,术后肛门外观平整,无畸形,肛门功能良好。结果表明,肛门后正中位切开手术治疗高位蹄铁型肛周脓肿和肛瘘,手术操作简单,手术时间短,术中寻找内口容易,患者痛苦小,愈合后瘢痕小,肛门功能好,疗效可靠。     

Anal fistula treatment with seton

The objectives of anal fistula treatment are to drain sepsis, irradicate the fistulous tract, and to preserve sphincter integrity and function. These goals can be achieved by either fistulotomy or fistulectomy. Alternative techniques include chemical setons, drainage setons, cutting setons and two-stage seton fistulotomy. We have treated 6 cases of trans-sphincteric fistula Parks type 2. The progressive fistulotomy technique was employed with a primary or one-stage cutting seton, as an outpatient procedure and without general anaesthetic. Complete division of the sphincter muscle took 18-27 days. No child presented incontinence or any other complications from the technique employed. No recurrences were observed at the 12 month follow-up. We conclude that the use of cutting setons is a simple and effective technique for the treatment of anal fistula in children, with low complication rates.     

瘘管外切+松挂线手术治疗复杂性肛瘘合并脓肿的评价

目的比较一期与分期外切松挂手术治疗复杂性肛瘘合并脓肿的临床疗效。 方法对2008年9月至2015年10月间88例复杂性肛瘘合并脓肿患者进行前瞻性随机研究,比较分析治疗组（53例,采用"一期瘘管外切+松挂"）和对照组（35例,采用"一期脓肿切开+二期肛瘘处理"）患者的临床特征、瘘型、术前及术后肛门功能状况（Wexner评分评估）、住院时间、治愈时间、复发率及并发症。 结果88例中最常见的肛瘘类型为肛管括约肌间瘘。治疗组与对照组的显愈率分别为92.5%和91.4%,差异无统计学意义（χ²=0.030,P=0.862）;治疗组术前及术后肛门失禁平均积分为1.8±1.3和1.9±1.3,对照组为1.7±1.5和2.0±1.2,两组差异无统计学意义（t=0.332、0.364,均P>0.05）;肛门失禁Wexner评分均在0~5分范围;尿潴留、轻微出血和伤口感染等并发症总发生率比较,组间差异无统计学意义（χ²=0.133,P=0.998）。术后随访0.5~4年,治疗组和对照组复发率比较差异无统计学意义（7.5% vs 8.6%,χ²=0.030,P=0.862）。治疗组的住院时间及创面痊愈时间分别为（5.9±0.3）d和（6.2±1.5）d,而对照组分别为（20.3±1.3）d和（25.2±1.2）d,差异有统计学意义（t=24.351、16.523,均P<0.01）,治疗组明显短于对照组。 结论一期"瘘管外切+松挂"手术与传统分期手术相比,具有痛苦小、疗程短、肛门功能保护好等优点,可成为治疗复杂性肛瘘合并脓肿的有效方法。     

Fistulotomy or seton in anal fistula: a decisional algorithm

Fistula in ano is a common proctological disease. Several authors stated that internal and external anal sphincters preservation is in the interest of continence maintenance. The aim of the present study is to report our experience using a decisional algorithm on sphincter saving procedures that achieved us to obtain good results with low rate of complications. From 2008 to 2011, 206 patients underwent surgical treatment for anal fistula; 28 patients underwent perianal abscess drainage plus seton placement of trans-sphincteric or supra-sphincteric fistula (13.6 %), 41 patients underwent fistulotomy for submucosal or low inter-sphincteric or low trans-sphincteric anal fistula (19.9 %) and 137 patients underwent partial fistulectomy or partial fistulotomy (from cutaneous plan to external sphincter muscle plan) and cutting seton placement without internal sphincterotomy for trans-sphincteric anal fistula (66.50 %). Healing rates have been of 100 % and healing times ranged from 1 to 6 months in 97 % of patients treated by setons. Transient fecal soiling was reported by 19 patients affected by trans-sphincteric fistula (11.5 %) for 4–6 months and then disappeared or evolved in a milder form of flatus occasional incontinence. No major incontinence has been reported also after fistulotomy. Fistula recurred in five cases of trans-sphincteric fistula treated by seton placement (one with abscess) (1/28) (3.5 %) and four with trans-sphincteric fistula (4/137) (3 %). Our algorithm permitted us to reduce to 20 % sphincter cutting procedures without reporting postoperative major anal incontinence; it seems to open an interesting way in the treatment of anal fistula.     

主管虚挂引流治疗高位复杂性肛瘘的临床对比观察

目的探讨主管虚挂引流治疗高位复杂性肛瘘的价值。方法 60例高位复杂性肛瘘患者随机分为试验组和对照组,每组30例。试验组采用主管虚挂引流术,对照组采用传统切挂术。结果两组治愈率差异无统计学意义(P0.05),但两组间的术后疼痛程度、疼痛持续天数、创口愈合天数差异有统计学意义(P0.05),在肛门功能评价方面,两组手术后及组间肛门失禁评分(Wexner评分)及肛门动力学测试差异有统计学意义(P0.05)。结论主管虚挂引流术在治疗高位复杂性肛瘘痛苦小、疗程短,能有效地保护肛门括约肌功能,是较实用的手术术式。     

Anal fistula plug and fibrin glue versus conventional treatment in repair of complex anal fistulas

Introduction

High transsphincteric fistulas are difficult to treat because fistulotomy of involved sphincter muscle results in incontinence. We compare our outcomes for anal fistula plug, fibrin glue, advancement flap closure, and seton drain insertion.

Methods

This is a retrospective study of patients treated for high transsphincteric anal fistulas. The primary outcome was full healing at 12 weeks postoperatively.

Results

Between 1997 and 2008, 232 patients with anal fistula were identified in the St. Paul's Hospital Anal Fistula Database. Postoperative healing rates at the 12-week follow-up for the fistula plug, fibrin glue, flap advancement, and seton drain groups were 59.3%, 39.1%, 60.4%, and 32.6%, respectively (P < .0001).

Conclusions

Closure of the primary fistula opening using a biological anal fistula plug and anal flap advancement result in similar fistula healing rates in patients with high transsphincteric fistulae. These 2 strategies are superior to seton placement and fibrin glue. Given the low morbidity and relative simplicity of the procedure, the anal fistula plug is a viable alternative treatment for patients with high transsphincteric anal fistulas.     

量化传统挂线疗法对高位肛瘘术后肛门功能影响的研究

目的 观察高位肛瘘术中不同程度挂线后肛门功能改变情况.方法 本研究共观察病例45例,分为3组,每组15例,均行低位切开高位挂线手术,以挂线勒割肌束收紧长度为分组观察依据.结果 肛管压力下降以静息压为著,1/4组下降为(15.09±2.91)%,1/3组为(24.77±1.15)%,1/2组为(33.32±1.91)%,...     

Endorectal flap advancement repair and fistulectomy for high trans-sphincteric and suprasphincteric fistulas

BACKGROUND: Low-lying trans-sphincteric anal fistulas respond well to simple fistulectomy or fistulotomy. However, management of high fistulas has long been a serious problem because of the necessity of preserving at least some of the sphincter mechanism. The clinical results of endorectal flap advancement and fistulectomy for complex anal fistulas were assessed. METHODS: A total of 103 consecutive patients with high trans-sphincteric (n = 91) and suprasphincteric (n = 12) fistulas undergoing endorectal advancement flap repair together with core fistulectomy were included in a prospective study. Clinical outcome was assessed in terms of continence and recurrence by an independent observer for a period of 1 year after operation. RESULTS: Successful healing was achieved in 96 patients (93 per cent). Recurrent fistula occurred in six (7 per cent) of the 91 patients in the trans-sphincteric group and in one of the 12 patients in the suprasphincteric group. Continence disturbance was noted in eight patients (8 per cent). Previous repair and the level of the fistula did not adversely affect the results obtained. CONCLUSION: Core fistulectomy associated with endorectal advancement flap repair is a safe and effective technique for any high trans-sphincteric and suprasphincteric fistula, with good results in terms of recurrence and anal continence.     

Faecal incontinence after seton treatment for anal fistulae with and without surgical division of internal anal sphincter: a systematic review

Objective The challenge of surgery for anal fistula is to eradicate the fistula track while maintaining anal continence. Seton placement is recommended to reduce postoperative faecal incontinence but interestingly a great range of functional impairment after surgery has been published. The aim of this study was to analyse the influence of intra‐operative internal anal sphincter division during tight or cutting seton technique for cryptogenic anal fistula, on the results of recurrence and postoperative faecal incontinence. Method A systematic literature review was performed to identify published series from 1966 to May 2007 of patients with anal fistula treated by a tight or cutting seton technique. The published series has been divided in to those where preservation of internal anal sphincter was performed (PIAS group) or where intra‐operative surgical division was undertaken in the time of seton placement (SIAS group) .The main endpoints of the review were to study anal fistula recurrence rate and postoperative faecal incontinence. Results Eighteen studies including 19 series and 448 patients were analysed in detail. Recurrence rate was 5.0% and 3.0% in PIAS and SIAS group respectively. Overall faecal incontinence rate was 5.6% in PIAS group and 25.2% in SIAS group. Conclusion Although based on low‐evidence studies, intra‐operative preservation of internal anal sphincter at the time of seton insertion for anal fistula seems to reduce the postoperative faecal incontinence without a substantial increase in recurrence rates.     

Outcomes of anal fistula surgery in patients with inflammatory bowel disease

Background

Anal fistulas in patients with Crohn's disease are especially difficult to manage because of nonhealing and incontinence. We reviewed our outcomes for the newer sphincter-preserving techniques of anal fistula plug and fibrin glue compared with standard treatments of advancement flap closure and seton drain insertion.

Methods

This was a retrospective study of patients with inflammatory bowel disease treated for high transsphincteric anal fistulas. The primary outcome was healing and continence at 12 weeks postoperatively.

Results

Between 1997 and 2009, 51 patients with anal fistulas and inflammatory bowel disease were identified in the St Paul's Hospital Anal Fistula Database. Postoperative healing rates at 12 weeks for the fistula plug, fibrin glue, flap advancement, and seton drain groups were 75%, 0%, 20%, and 28%, respectively. Continence scores were not altered by these procedures.

Conclusions

Closure of the primary fistula opening in patients with inflammatory bowel disease using a biologic anal fistula plug had improved healing compared with fibrin glue, seton drain, and flap advancement. Given its low morbidity and relative simplicity, the anal fistula plug should be considered for treating high transsphincteric anal fistulas in patients with inflammatory bowel disease.