一期原位取皮适形植皮术在低位单纯性括约肌间型肛瘘手术中的应用(附32例报道)

One-stage,personalized skin grafting for low simple intersphincteric anal fistula:a case series of 32 patients

目的分析一期原位取皮适形植皮术在低位单纯性括约肌间型肛瘘手术中的应用效果。方法纳入2016年12月至2020年3月在广州中医药大学第一附属医院诊断为肛门后位低位单纯性括约肌间型肛瘘,并接受肛瘘切除+一期原位取皮适形植皮术治疗的32例患者临床资料进行分析。记录创面愈合时间、植皮相关并发症、术后肛门外观、术后肛门功能及复发情况。结果在32例患者中,术后创面愈合时间12~21 d,平均创面愈合时间为(14.2±2.7)d;无1例患者术后因皮下血肿、皮下积液或感染化脓导致皮片完全或部分坏死脱落;4例患者因皮片浮动、移位导致局部缺血,进而部分皮片坏死脱落,伤口二期愈合良好。术后6个月,21例患者(遵嘱返院复诊)肛门外观均正常,手术瘢痕不明显,均未见“钥匙孔”畸形。术后6个月,通过门诊复查或电话对32例患者进行随访,Wexner肛门失禁评分均为0分。术后12个月,32例患者均未见复发。结论在肛门后位低位单纯性括约肌间型肛瘘的治疗中,完成肛瘘切除术后采用一期原位取皮适形植皮术可充分利用病灶投影区域皮源、避免由他处取皮所带来的副损伤,在促进创面愈合、减少术后并发症方面具有一定的优势。

Objectives To analyze the efficacy of one-stage,personalized skin grafting for low simple intersphincteric anal fistu⁃la.Methods Clinical data from 32 patients with low simple intersphincteric anal fistula treated at the First Affiliated Hospital of Guangzhou University of Chinese Medicine between December 2016 and March 2020 were analyzed.All patients received fistu⁃lectomy and one-stage,personalized skin grafting.Time to wound healing,complications related to skin grafting,anal morphology and function after surgery,and recurrence were recorded.Results Of the 32 patients,time to wound healing ranged from 12 to 21 days with a mean(SD)of 14.2(2.7)days.No patients had partial or complete necrosis and shedding of the skin graft due to subcutaneous hematoma,subcutaneous effusion,or infection suppuration;four patients reported local necrosis and shedding of the skin graft due to skin floating and displacement.These wounds healed after secondary intervention.At 6 months after surgery,21 patients returned to clinic as instructed;all 21 patients had normal anal morphology with no apparent scars and no keyholelike deformity.At 6 months after surgery,the 32 patients were followed up either via clinical visit or telephone interview;all pa⁃tients had Wexner anal incontinence score of 0.At 12 months after surgery,no patients had recurrence.Conclusion For pa⁃tients with low simple intersphincteric anal fistula,one-stage,personalized skin grafting after fistulectomy can utilize skin source from corresponding lesion area while avoiding secondary injury when using heterotopic skin source.It has certain advantages in promoting wound healing and reducing postoperative complications.