经括约肌间切开联合挂线引流治疗28例马蹄形肛瘘的临床疗效研究

Transanal opening of intersphincteric space and seton drainage for horseshoe fistula: an analysis of 28 patients

目的本研究旨在评估经括约肌间切开联合挂线引流治疗马蹄形肛瘘的近期预后和术后肛门功能情况。方法回顾性研究分析2016年7月至2019年3月在中山大学附属第六医院接受保留外括约肌的松弛挂线治疗的28例马蹄形肛瘘患者临床资料,分析患者手术相关情况、术后并发症、肛门功能情况、治疗效果,以及治疗满意度。结果28例患者均顺利完成马蹄形肛瘘行经括约肌间切开联合挂线引流的保留外括约肌手术,平均手术时间为(38.93±8.32)min,平均术中出血量为(24.46±9.36)mL。患者术后第1天、3天、5天、7天及术后第1次排便时患者VAS评分中位数分别为3(2,6)分、2(2,5)分、2(1,5)分、1(1,3)分及3(2,6)分。术中、术后均未出现严重并发症,术后均未出现肛门狭窄情况。术前Wexner失禁评分为0(0,1)分,术后3个月为0(0,2)分,二者比较差异有统计学意义(P<0.05)。术后随访6~38个月,中位随访时间为17个月,28例患者中25例治愈、3例复发。自患者入院至术后6个月进行电话随访,患者表示“非常满意”24例、“满意”4例。结论经括约肌间切开联合挂线引流术是一种治疗马蹄形肛瘘的有效术式,并且可以很好地保护肛门括约肌功能,更高级别的证据有待大样本量的临床随机对照研究进一步证实。

Objectives To investigate short-term prognosis and postoperative anal function of transanal opening of intersphincter ic space and seton drainage for horseshoe fistula. Methods This was a retrospective analysis of 28 patients with horseshoe fistu la treated with transanal opening of intersphincteric space and seton drainage at the Sixth Affiliated Hospital of Sun Yat-sen Uni versity between July 2016 and March 2019. The following were recorded: surgical parameters, postoperative complications, anal function, effectiveness, and patients’ satisfaction. Results External sphincter- preserved transanal opening of intersphincteric space and seton drainage was performed uneventfully in all 28 patients. The average duration of surgery was (38.93±8.32) min,and the average intraoperative blood loss was (24.46±9.36) mL. Median visual analog scale pain score for bowel movement on the 1 st , 3 rd , 5 th , and 7 th day and the first time after surgery was 3(2, 6), 2(2,5), 2(1, 5), 1(1, 3) and 3(2, 6), respectively. No se vere complications occurred during and after surgery. No anal stenosis occurred after surgery. Median Wexner incontinence score before surgery was 0(0, 1) and 0(0, 2) at 3 months after surgery respectively, with significant change (P < 0.05). Patients were fol lowed up for 6~38 months (median: 17 months). Twenty-five patients were cured, and three had recurrence. Telephone follow-up was performed since admission till 6 months after surgery. Twenty-four patients reported‘very satisfied’and four reported‘satis fied’. Conclusion Transanal opening of intersphincteric space and seton drainage was an effective procedure for horseshoe fistu la. It could effectively preserve sphincter function. Further large randomized controlled trials are required to confirm our findings.