Cintron J R, Park J J, Orsay C P, Pearl R K, Nelson R L, Abcarian H
Department of Surgery, University of Illinois Hospital and Clinics, Chicago, USA.
Dis Colon Rectum. 1999 May;42(5):607-13. doi: 10.1007/BF02234135.
Our goal was to determine if autologous fibrin tissue adhesive derived from the precipitation of fibrinogen using a combination of ethanol and freezing, could be used to completely close both simple and complex fistulas-in-ano.
A 26-patient pilot study was performed in which 100 ml of a patient's blood was drawn 90 minutes before surgery. Autologous fibrin tissue adhesive was prepared. In the operating room the patient underwent an examination under anesthesia, and the primary and secondary fistula tract openings were attempted to be identified. The fistula tract was curetted, and autologous fibrin tissue adhesive was injected into the secondary fistula tract opening until fibrin glue was seen coming from the primary opening. A petroleum jelly gauze was then applied over the secondary opening, and the patient was sent home. Follow-up visits were scheduled for one week, one month, three months, and one year later.
Twenty-six patients received autologous fibrin tissue adhesive fistula injections, with a mean follow-up of 3.5 months. Initial results were encouraging. Twenty-one of 26 patients (81 percent) had successful initial closure of their fistulas. Two of five failures were injected a second time, and one closed, giving an overall successful closure rate of 85 percent (22/26 patients). Of five patients who failed, mean time to failure was 3.8 weeks. In addition, there was no evidence of infection or complications related to the procedure.
Our initial results are optimistic and require further support through longer follow-up data. Fibrin glue treatment of anorectal fistulas offers a unique mode of management that is safe, simple, and easy for the surgeon to perform. By using autologous fibrin tissue adhesive the patient avoids the risk of anal incontinence and the discomfort of prolonged wound healing which may be associated with fistulotomy.
我们的目标是确定通过乙醇和冷冻相结合沉淀纤维蛋白原得到的自体纤维蛋白组织粘合剂是否可用于完全闭合单纯性和复杂性肛瘘。
进行了一项纳入26例患者的初步研究，术前90分钟抽取患者100毫升血液，制备自体纤维蛋白组织粘合剂。在手术室中，患者接受麻醉下检查，试图识别原发和继发瘘管开口。刮除瘘管，将自体纤维蛋白组织粘合剂注入继发瘘管开口，直至看到纤维蛋白胶从原发开口流出。然后在继发开口处覆盖凡士林纱布，患者出院。安排在术后1周、1个月、3个月和1年进行随访。
26例患者接受了自体纤维蛋白组织粘合剂瘘管注射，平均随访3.5个月。初步结果令人鼓舞。26例患者中有21例（81%）初次瘘管闭合成功。5例失败患者中有2例再次注射，其中1例闭合，总体成功闭合率为85%（22/26例患者）。5例失败患者中，平均失败时间为3.8周。此外，没有证据表明存在与该手术相关的感染或并发症。
我们的初步结果令人乐观，需要通过更长时间的随访数据进一步支持。纤维蛋白胶治疗肛瘘提供了一种独特的治疗方式，对手术医生来说安全、简单且易于操作。使用自体纤维蛋白组织粘合剂，患者可避免肛门失禁的风险以及与肛瘘切开术相关的伤口长期愈合带来的不适。
