改良经括约肌间瘘管结扎术治疗单纯性经括约肌型肛瘘的临床疗效

目的：探讨改良经括约肌间瘘管结扎术（LIFT术）治疗单纯性经括约肌型肛瘘的疗效及安全性。方法前瞻性入组杭州市第三人民医院肛肠科自2012年10月至2014年1月连续收治的70例单纯性经括约肌型肛瘘患者，按照随机数字表法将患者随机分为改良LIFT组（37例，自外口沿瘘管走形紧贴瘘管壁，隧道式游离经外括约肌瘘管至括约肌间沟，切除外侧已游离瘘管）和常规LIFT组（33例）。比较两组的术中及术后情况，并于术后3月检测盆底肌电图以及肛门直肠压力来评估肛门功能。结果两组患者手术时间、术后疼痛评分、住院时间及愈合时间比较，差异均无统计学意义（均P＞0．05）。术后随访3～20（中位数12）月，改良LIFT组治愈率83．8％（31／37），明显高于常规LIFT组的60．6％（20／33）（P＝0．029）。改良LIFT组术后4例患者创面持续不愈，2例复发；常规LIFT组术后8例患者创面持续不愈，5例复发；两组均无肛门失禁发生。术后3月盆底肌电图和肛门直肠测压显示，两组患者运动单位电位时限、单纯相出现率、肛管静息压和肛管最大收缩压差异均无统计学意义（均P＞0．05）。结论与常规LIFT术相比，改良LIFT术治疗单纯性经括约肌型肛瘘具有更高的治愈率，且能达到与常规LIFT术同等程度的肛门功能。

Modified ligation of the intersphincteric fistula tract in the treatment of simple transsphincteric perianal fistula

Objective To assess the efficacy and safety of modified ligation of the intersphincteric fistula tract for simple transsphincteric perianal fistula. Methods Seventy patients with simple transsphincteric perianal fistula between October 2012 and January 2014 in our department were prospectively enrolled. According to the random number table , patients were divided into two groups：modified-LIFT group （37 cases, from the external opening close to the fistula, dissect the external sphincter fistula to the intersphincteric groove by tunneling technique, resect the lateral free fistula） and LIFT group （33 cases）. Clinical parametres before and after operation were compared, and results of pelvic electromyogram （EMG） and anorectal manometry three months after operation were analyzed to evaluated anal function. Results The operative time, pain score, hospital stay, and healing time were not significantly different between the two groups （all P〉0.05）. During the median follow-up of 12 months （ 3-20 months ） , the healing rate in modified-LIFT group was 83 . 8%（ 31/37 ） , which was significantly higher than 60%（20/33） in LIFT group （P=0.029）. After operation, 4 patients had persistent unhealed wound, 2 recurred in modified-LIFT group, while 8 patients had persistent unhealed wound, and 5 recurred in LIFT group. No patients developed anal incontinence. By the pelvic EMG and anorectal manometry 3 months after operation, the duration of motor unit potential, occurrence of simple phase, mean resting pressure and maximun squeeze pressure were not significantly different. Conclusion Modified-LIFT procedure for the management of simple transsphincteric perianal fistulas is a simple and effective operation with higher healing rate and similar anal function as LIFT.