目的评价经括约肌间瘘管结扎术(ligation of the intersphincteric fistula tract,LIFT)联合直肠推移瓣术(endorectal advancement flap,ERAF)治疗高位复杂性肛瘘的临床疗效。方法2016年8月~2021年12月我院收治的高位复杂性肛瘘病人40例...目的评价经括约肌间瘘管结扎术(ligation of the intersphincteric fistula tract,LIFT)联合直肠推移瓣术(endorectal advancement flap,ERAF)治疗高位复杂性肛瘘的临床疗效。方法2016年8月~2021年12月我院收治的高位复杂性肛瘘病人40例,根据抽签法随机分成试验组和对照组,每组各20例。试验组采用LITF+ERAF,对照组采用LIFT,随访6~12个月,比较其临床疗效,比较创面愈合时间、治愈率、术后第1天疼痛程度、肛门功能和复发率。结果两组术后第1天疼痛程度、创面愈合时间、治愈率比较差异无统计学意义(P>0.05)。两组术前、创面愈合后、术后6个月的Wexner肛门失禁评分、肛管静息压和肛管最大收缩压比较差异无统计学意义(P>0.05);两组创面愈合后、术后6个月的肛管静息压和肛管最大收缩压分别与其自身术前比较,差异有统计学意义(P<0.05)。随访6~12个月,试验组无复发,对照组复发3例,差异有统计学意义(P<0.05)。结论LITF联合ERAF疗效好、痛苦小、病程短、术后复发率低、肛门功能影响小。展开更多
目的:观察直肠黏膜推移皮瓣术(ERAF)联合中药熏洗治疗低位单纯性肛瘘的效果。方法:选取2020年1月—2022年9月梅州市人民医院收治的60例低位单纯性肛瘘患者,采用随机数字表法分为对照组与观察组各30例。对照组给予低位单纯性肛瘘切除术+...目的:观察直肠黏膜推移皮瓣术(ERAF)联合中药熏洗治疗低位单纯性肛瘘的效果。方法:选取2020年1月—2022年9月梅州市人民医院收治的60例低位单纯性肛瘘患者,采用随机数字表法分为对照组与观察组各30例。对照组给予低位单纯性肛瘘切除术+高锰酸钾坐浴;观察组给予ERA+中药熏洗。比较两组患者临床总有效率、Wexner评分、肛门功能受损发生率、伤口愈合时间、住院时间、疼痛视觉模拟评分(VAS)。结果:两组临床总有效率均为100.00%,差异无统计学意义(P>0.05)。两组均无并发症发生。术后两组的肛门Wexner评分比较,差异无统计学意义(P>0.05)。观察组肛门功能受损发生率低于对照组,但差异无统计学意义(P>0.05);观察组伤口愈合时间、住院时间低于对照组,差异有统计学意义(P<0.05);术后第1、3、5 d,观察组患者的VAS评分低于对照组,差异有统计学意义(P<0.05);观察组有1例复发患者,复发率为3.33%(1/30),对照组患者无复发情况。结论:对低位单纯性肛瘘患者行E R A F术联合中药熏洗进行治疗时,治疗总有效率与单纯性肛瘘切除术相同,术后无并发症发生。但直肠黏膜推移皮瓣术联合中药熏洗治疗,能缩短伤口愈合时间、住院时间,减轻患者术后疼痛感。展开更多
INTRODUCTION: We report on a patient cohort with dorsal horseshoe fistulas-in-ano. We sought to answer the question of whether these fistulas can be operatively treated, implementing a sphincter-preserving fistulectom...INTRODUCTION: We report on a patient cohort with dorsal horseshoe fistulas-in-ano. We sought to answer the question of whether these fistulas can be operatively treated, implementing a sphincter-preserving fistulectomy with primary closure of the internal opening, as is done when treating transsphincteric anal fistulas. Long-term clinical course is examined here and operative methods are discussed. METHODS: During the time period from 1985 to 2000, 42 patients (29 men, 13 women)-with an average age of 44 ±11 years were operatively treated for horseshoe fistulas-in-ano originating in cryptoglandular regions. Twenty patients originally had an abscess, which was surgically drained and then a seton was placed in the tract of the fistula. Later, a fistulectomy or curettage of the fistula tract with primary closure of the internal fistula opening was performed in all patients without severing the sphincter muscle. We implemented four different surgical techniques to facilitate this closure: the mucosa-submucosa advancement flap, the rectal wall advancement flap (part or full thickness), the ano-cutaneous advancement flap, and direct closure without any further mobilization. The follow-up averaged 58 months (1-14 years). RESULTS: Thirty-seven of the 42 fistulas (88 percent) healed. In 31 patients, restitution occurred after the first operation, in 4 patients after the second operation and in 2 patients after the third operation. One patient developed a recurrence after the first operation and died from secondary causes before a second operation was performed. The other four patients were listed as unclear, because the time of observation was less than one year. The total recurrence rate of flap procedures is 23 percent (mucosa-submucosa advancement flap, 25 percent; rectal wall advancement flap, 35 percent; anocutaneous advancement flap, 25 percent; direct closure, 0 percent; not significant). Thirty-four (81 percent) of the 42 patients had previously been operatively treated on an average of three times. Twelve patients developed deficits in continence. Eight patients developed minor deficits, which included incontinence for flatus and problems with staining. Four patients became incontinent for liquid stools. There was a significant decrease in manometric resting pressure of 25 percent (from 123 ±40 cm H2O to 91 ±29 cm H2O) and in squeeze pressure of 21 percent (from 262 ±70 cm H2O to 207 ±66 cm H2O). CONCLUSIONS: As in other high anal fistulas, horseshoe-shaped anal fistulas can be operatively treated implementing a fistulectomy combined with any of the above-mentioned forms of closure of the internal fistula opening, with good success rates and acceptable postoperative continence. Sufficient drainage of the retroanal region is of utmost importance. Through these measures, it is possible to avoid severing the sphincter muscle and to prevent an anal canal deformation (keyhole deformity).展开更多
文摘目的评价经括约肌间瘘管结扎术(ligation of the intersphincteric fistula tract,LIFT)联合直肠推移瓣术(endorectal advancement flap,ERAF)治疗高位复杂性肛瘘的临床疗效。方法2016年8月~2021年12月我院收治的高位复杂性肛瘘病人40例,根据抽签法随机分成试验组和对照组,每组各20例。试验组采用LITF+ERAF,对照组采用LIFT,随访6~12个月,比较其临床疗效,比较创面愈合时间、治愈率、术后第1天疼痛程度、肛门功能和复发率。结果两组术后第1天疼痛程度、创面愈合时间、治愈率比较差异无统计学意义(P>0.05)。两组术前、创面愈合后、术后6个月的Wexner肛门失禁评分、肛管静息压和肛管最大收缩压比较差异无统计学意义(P>0.05);两组创面愈合后、术后6个月的肛管静息压和肛管最大收缩压分别与其自身术前比较,差异有统计学意义(P<0.05)。随访6~12个月,试验组无复发,对照组复发3例,差异有统计学意义(P<0.05)。结论LITF联合ERAF疗效好、痛苦小、病程短、术后复发率低、肛门功能影响小。
文摘目的:观察直肠黏膜推移皮瓣术(ERAF)联合中药熏洗治疗低位单纯性肛瘘的效果。方法:选取2020年1月—2022年9月梅州市人民医院收治的60例低位单纯性肛瘘患者,采用随机数字表法分为对照组与观察组各30例。对照组给予低位单纯性肛瘘切除术+高锰酸钾坐浴;观察组给予ERA+中药熏洗。比较两组患者临床总有效率、Wexner评分、肛门功能受损发生率、伤口愈合时间、住院时间、疼痛视觉模拟评分(VAS)。结果:两组临床总有效率均为100.00%,差异无统计学意义(P>0.05)。两组均无并发症发生。术后两组的肛门Wexner评分比较,差异无统计学意义(P>0.05)。观察组肛门功能受损发生率低于对照组,但差异无统计学意义(P>0.05);观察组伤口愈合时间、住院时间低于对照组,差异有统计学意义(P<0.05);术后第1、3、5 d,观察组患者的VAS评分低于对照组,差异有统计学意义(P<0.05);观察组有1例复发患者,复发率为3.33%(1/30),对照组患者无复发情况。结论:对低位单纯性肛瘘患者行E R A F术联合中药熏洗进行治疗时,治疗总有效率与单纯性肛瘘切除术相同,术后无并发症发生。但直肠黏膜推移皮瓣术联合中药熏洗治疗,能缩短伤口愈合时间、住院时间,减轻患者术后疼痛感。
文摘INTRODUCTION: We report on a patient cohort with dorsal horseshoe fistulas-in-ano. We sought to answer the question of whether these fistulas can be operatively treated, implementing a sphincter-preserving fistulectomy with primary closure of the internal opening, as is done when treating transsphincteric anal fistulas. Long-term clinical course is examined here and operative methods are discussed. METHODS: During the time period from 1985 to 2000, 42 patients (29 men, 13 women)-with an average age of 44 ±11 years were operatively treated for horseshoe fistulas-in-ano originating in cryptoglandular regions. Twenty patients originally had an abscess, which was surgically drained and then a seton was placed in the tract of the fistula. Later, a fistulectomy or curettage of the fistula tract with primary closure of the internal fistula opening was performed in all patients without severing the sphincter muscle. We implemented four different surgical techniques to facilitate this closure: the mucosa-submucosa advancement flap, the rectal wall advancement flap (part or full thickness), the ano-cutaneous advancement flap, and direct closure without any further mobilization. The follow-up averaged 58 months (1-14 years). RESULTS: Thirty-seven of the 42 fistulas (88 percent) healed. In 31 patients, restitution occurred after the first operation, in 4 patients after the second operation and in 2 patients after the third operation. One patient developed a recurrence after the first operation and died from secondary causes before a second operation was performed. The other four patients were listed as unclear, because the time of observation was less than one year. The total recurrence rate of flap procedures is 23 percent (mucosa-submucosa advancement flap, 25 percent; rectal wall advancement flap, 35 percent; anocutaneous advancement flap, 25 percent; direct closure, 0 percent; not significant). Thirty-four (81 percent) of the 42 patients had previously been operatively treated on an average of three times. Twelve patients developed deficits in continence. Eight patients developed minor deficits, which included incontinence for flatus and problems with staining. Four patients became incontinent for liquid stools. There was a significant decrease in manometric resting pressure of 25 percent (from 123 ±40 cm H2O to 91 ±29 cm H2O) and in squeeze pressure of 21 percent (from 262 ±70 cm H2O to 207 ±66 cm H2O). CONCLUSIONS: As in other high anal fistulas, horseshoe-shaped anal fistulas can be operatively treated implementing a fistulectomy combined with any of the above-mentioned forms of closure of the internal fistula opening, with good success rates and acceptable postoperative continence. Sufficient drainage of the retroanal region is of utmost importance. Through these measures, it is possible to avoid severing the sphincter muscle and to prevent an anal canal deformation (keyhole deformity).
