目的探讨经直肠推移瓣术(endorectal advancement flap,ERAF)联合括约肌间瘘结扎术(ligation of the intersphincteric fistula tract,LIFT)治疗高位单纯型肛瘘的临床疗效。方法选取2022年3—9月北京市肛肠医院(北京市二龙路医院)高位...目的探讨经直肠推移瓣术(endorectal advancement flap,ERAF)联合括约肌间瘘结扎术(ligation of the intersphincteric fistula tract,LIFT)治疗高位单纯型肛瘘的临床疗效。方法选取2022年3—9月北京市肛肠医院(北京市二龙路医院)高位单纯型肛瘘住院患者84例,按照随机数字表法分为观察组和对照组,每组42例。观察组采用ERAF联合LIFT,对照组采用传统切除挂线术。比较治疗后两组视觉模拟评分(visual analogue scale,VAS)、临床疗效及并发症情况。结果84例患者中,男58例、女26例,年龄27~59岁,平均(32.6±6.8)岁。观察组术后第1天、第3天、第7天的VAS低于对照组[(5.24±1.08)分比(7.19±1.35)分,(4.76±1.11)分比(6.21±1.09)分,(2.34±0.54)分比(2.98±0.61)分],出血量、住院时间及伤口愈合时间低于对照组[(7.83±1.62)ml比(12.66±2.46)ml,(3.75±1.66)d比(4.55±1.71)d,(28.15±8.65)d比(39.12±10.23)d],术后2个月Wexner评分及肛管收缩压低于对照组[(3.28±0.63)分比(4.46±0.75)分,(178.49±8.82)mmHg比(186.22±10.29)mmHg,1 mmHg=0.133 kPa],肛管静息压高于对照组[(45.88±2.87)mmHg比(43.85±1.74)mmHg],并发症发生率低于对照组(11.90%比33.33%),差异均有统计学意义(P<0.05);两组手术时间的比较,差异无统计学意义(P>0.05)。结论相较于传统肛瘘切除挂线术,ERAF联合LIFT具有患者出血量少、痛苦小、病程短、恢复快等优点,值得临床推广。展开更多
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
Anal fistula is among the most common illnesses affecting man.Medical literature dating back to 400 BC has discussed this problem.Various causative factors have been proposed throughout the centuries,but it appears th...Anal fistula is among the most common illnesses affecting man.Medical literature dating back to 400 BC has discussed this problem.Various causative factors have been proposed throughout the centuries,but it appears that the majority of fistulas unrelated to specific causes (e.g.Tuberculosis,Crohn’s disease) result from infection (abscess) in anal glands extending from the intersphincteric plane to various anorectal spaces.The tubular structure of an anal fistula easily yields itself to division or unroofing (fistulotomy) or excision (fistulectomy) in most cases.The problem with this single,yet effective,treatment plan is that depending on the thickness of sphincter muscle the fistula transgresses,the patient will have varying degrees of fecal incontinence from minor to total.In an attempt to preserve continence,various procedures have been proposed to deal with the fistulas.These include: (1) simple drainage (Seton);(2) closure of fistula tract using fibrin sealant or anal fistula plug;(3) closure of primary opening using endorectal or dermal flaps,and more recently;and (4) ligation of intersphincteric fistula tract (LIFT).In most complex cases (i.e.Crohn’s disease),a proximal fecal diversion offers a measure of symptom-atic relief.The fact remains that an "ideal" procedure for anal fistula remains elusive.The failure of each sphincter-preserving procedure (30%-50% recurrence) often results in multiple operations.In essence,the price of preservation of continence at all cost is multiple and often different operations,prolonged disability and disappointment for the patient and the surgeon.Nevertheless,the surgeon treating anal fistulas on an occasional basis should never hesitate in referring the patient to a specialist.Conversely,an expert colorectal surgeon must be familiar with many different operations in order to selectively tailor an operation to the individual patient.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Anal fistula is among the most common illnesses affecting man.Medical literature dating back to 400 BC has discussed this problem.Various causative factors have been proposed throughout the centuries,but it appears that the majority of fistulas unrelated to specific causes (e.g.Tuberculosis,Crohn’s disease) result from infection (abscess) in anal glands extending from the intersphincteric plane to various anorectal spaces.The tubular structure of an anal fistula easily yields itself to division or unroofing (fistulotomy) or excision (fistulectomy) in most cases.The problem with this single,yet effective,treatment plan is that depending on the thickness of sphincter muscle the fistula transgresses,the patient will have varying degrees of fecal incontinence from minor to total.In an attempt to preserve continence,various procedures have been proposed to deal with the fistulas.These include: (1) simple drainage (Seton);(2) closure of fistula tract using fibrin sealant or anal fistula plug;(3) closure of primary opening using endorectal or dermal flaps,and more recently;and (4) ligation of intersphincteric fistula tract (LIFT).In most complex cases (i.e.Crohn’s disease),a proximal fecal diversion offers a measure of symptom-atic relief.The fact remains that an "ideal" procedure for anal fistula remains elusive.The failure of each sphincter-preserving procedure (30%-50% recurrence) often results in multiple operations.In essence,the price of preservation of continence at all cost is multiple and often different operations,prolonged disability and disappointment for the patient and the surgeon.Nevertheless,the surgeon treating anal fistulas on an occasional basis should never hesitate in referring the patient to a specialist.Conversely,an expert colorectal surgeon must be familiar with many different operations in order to selectively tailor an operation to the individual patient.
