视频辅助治疗肛瘘的临床研究进展

Research progress of video-assisted anal fistula treatment for anal fistula

目的总结视频辅助治疗肛瘘(VAAFT)的临床研究进展。方法复习国内外有关文献,对VAAFT的理论依据、操作方法、优缺点、注意事项及临床应用进行总结。结果 VAAFT是通过内镜处理瘘管,无需瘘管切开或切除,具有手术创伤小、术后恢复快,对肛门括约肌影响小等优势。该手术的缺点是适应证较严格,瘘管过于弯曲或者马蹄形肛瘘不适合采用该方法;另外,该手术采用的内镜为硬质镜管,操作起来不够方便,需要今后进行技术改进。在临床实践中开展VAAFT时,应该注意区分真性瘘管和假性瘘管;瘘管壁烧灼应充分,坏死组织应清理干净;内口的处理一定要确切;术后禁食,适当推迟首次排便时间,降低感染发生率。目前,国外对VAAFT的临床报道逐渐增多,这些报道均取得了较好的治疗效果,提示该方法是一种治疗肛瘘的安全而有效的微创手术方式。然而,国内对VAAFT的临床报道尚较少,目前处于初步探索阶段。结论 VAAFT是近年来治疗肛瘘的新技术,具有微创、保留肛门括约肌等优点,值得临床推广应用。

Objective To summarize the research progression of video-assisted anal fistula treatment （VAAFT）. Methods The related literatures in recent years were reviewed, and then the operation principle, operation process, advantages and disadvantages, matters needing attention, and clinical application of VAAFT were summarized. Results VAAFT is the treatment of fistulas by endoscopy. It don＇t require the incision or resection of the fistula. It has the advantages of less surgical trauma, faster postoperative recovery, and less impact on the anal sphincter. The disadvantage of this method is relatively strict indications, fistula bending or horseshoe fistula is not suitable for this method. In addition, the endoscope using during the operation is a rigid mirror tube, and the operation is not convenient enough, so technical improvement is needed in the future. We should pay attention to distinguish true fistula and false fistula in clinical practice; the wall of the fistula should be adequately burned and the necrotic tissue should be cleaned; the treatment of the internal opening of anal fistula must be exact; the time of the first defecation should be appropriately delayed, and the incidence of infection should be reduced after operation. At present, the clinical reports of VAAFT are increasing gradually in foreign countries, and these reports have achieved good therapeutic effect. It is considered that this method maybe a safe and effective minimally invasive surgical treatment for anal fistula. However, there is few clinical reports on VAAFT in China, and it is still in the preliminary stage of exploration. Conclusion VAAFT is a new technology in the treatment of anal fistula, and it has advantages of minimally invasive, sphincter preservation, and so on, which is worthy of clinical application.