60例括约肌间瘘管结扎术治疗高位经括约肌肛瘘的效果分析:10年临床应用与观察

Efficacy of the ligation of intersphincteric fistula tract to treat high transsphincter⁃ic anal fistula in 60 patients:ten years of clinical practice and observation

目的分析括约肌间瘘管结扎术(LIFT)治疗高位经括约肌肛瘘的疗效。方法对2009年11月至2019年10月在江苏省中医院肛肠科行LIFT的60例患者临床资料进行回顾性分析,包括手术相关资料、手术疗效、术后肛门功能及疾病相关资料。结果所有患者均手术顺利,中位手术时间为48.9(40.0,60.0)min,未出现术中及术后并发症。中位随访时间85.5(24.0,94.0)个月,其中失访4例(6.7%)。总体治愈率为71.4%。16例(28.6%)手术治疗失败,其中6例(10.7%)转变成括约肌间肛瘘,10例(17.9%)瘘管持续存在或复发。仅有1例患者在术后随访中诉当排气较多时有少量溢液,其余患者未诉特殊不适。手术治愈与手术失败患者在瘘管长度、既往脓肿/肛瘘手术史、外口/瘘管的数量、瘘管位置方面比较,差异均无统计学意义(均P>0.05)。结论在良好把握治疗适应证及术中精细操作的前提下,LIFT是一种安全、有效的保留括约肌术式,治愈效果良好,对肛门功能的影响甚微。

Objectives To investigate the efficacy of the ligation of intersphincteric fistula tract(LIFT)for treating high trans⁃sphincteric anal fistula.Methods This was a retrospective analysis of 60 patients who received LIFT at the Department of Ano⁃rectal Diseases,Jiangsu Province Hospital of Chinese Medicine,between November 2009 and October 2019.Information regarding surgery,efficacy,postoperative anal function and indices regarding anal fistula were recorded.Results All surgeries were un⁃eventful.The median operation time was 48.9(40.0,60.0)min.There were no intra-or postoperative complications.Patients were followed up for a median of 85.5(24.0,94.0)months.Four(6.7%)patients were lost to follow-up.The overall cure rate was 71.4%.Sixteen(28.6%)surgeries were unsuccessful,including six(10.7%)conversions to intersphincter fistula and ten(17.9%)persistent or recurrent fistula.During the follow-up,only one patient complained minor seepage when there was quite a few anal exhaust.Other patients experienced no discomfort.The length of fistula tract,personal history of anal abscess or fistula sur⁃gery,the number of external orifice or fistula tracts,and the location of fistula tract were similar between patients who had and who did not have successful surgery(P>0.05).Conclusion With appropriate indications and good techniques,LIFT was a safe sphincter-sparing surgery.It could achieve good clinical outcomes and had limited impact on anal function.