Mylonakis E, Katsios C, Godevenos D, Nousias B, Kappas A M
Academic Department of Surgery, University Hospital of Ioannina, Ioannina, Greece.
Colorectal Dis. 2001 Nov;3(6):417-21. doi: 10.1046/j.1463-1318.2001.00276.x.
This study was undertaken to assess the quality of life of patients after surgical treatment of anal fistula and to investigate whether anal manometry (AM) can guide the choice of the proper surgical intervention in these patients in order to protect the sphincter mechanism.
One hundred patients with anal fistula (AF) were studied prospectively (78 men; mean age 45 years; range 11-78). Cleveland Incontinence Score (CIS) was record pre-operatively and 1 and 3 months postoperatively for each patient in order to specify their quality of life (QOL) before and after the surgical treatment. Also, anal manometry (AM) was performed pre-operatively and 1 month postoperatively. The pre-operative anal pressures and the type of fistula determined the kind of the surgical treatment. 55 patients had an intersphincteric fistula, 42 trans-sphincteric and 3 suprasphincteric. 65 patients underwent laying open of the fistulous track, 7 fistulectomy and 28 were treated by seton fistulotomy.
Three patients had defective gas control and 6 reported some degree of soiling. 3 patients developed recurrent fistula. CIS was significantly impaired (P=0.02) at the first postoperative month in these patients who were treated for trans-sphincteric fistula by fistulotomy; AM revealed significant decrease of anal pressures in these patients (resting and squeeze; P=0.007 and 0.0001 respectively); CIS and AM in the remaining cases revealed no significant deterioration of QOL and fall of anal pressures respectively. CIS was normal in the vast majority of patients at 3-months postoperatively.
QOL of patients after surgical treatment of AF is unalterable on the understanding that the AF is simple and the treatment is not associated by incontinence or recurrence. Pre-operative AM is important regarding the choice of the proper surgical procedure.
本研究旨在评估肛瘘手术治疗后患者的生活质量，并探讨肛门测压（AM）是否能指导这些患者选择合适的手术干预措施以保护括约肌功能。
前瞻性研究了100例肛瘘患者（78例男性；平均年龄45岁；范围11 - 78岁）。为明确每位患者手术治疗前后的生活质量（QOL），术前、术后1个月及3个月记录克利夫兰失禁评分（CIS）。此外，术前及术后1个月进行肛门测压（AM）。术前肛门压力及肛瘘类型决定手术治疗方式。55例为括约肌间肛瘘，42例为经括约肌肛瘘，3例为括约肌上肛瘘。65例行瘘管切开术，7例行瘘管切除术，28例行挂线肛瘘切开术。
3例患者气体控制不佳，6例报告有不同程度的粪便污染。3例出现复发性肛瘘。经括约肌肛瘘行瘘管切开术治疗的患者术后第1个月CIS显著受损（P = 0.02）；AM显示这些患者的肛门压力显著降低（静息和收缩时；分别为P = 0.007和0.0001）；其余病例的CIS和AM分别显示生活质量无显著恶化及肛门压力无下降。绝大多数患者术后3个月CIS正常。
若肛瘘简单且治疗未伴有失禁或复发，则肛瘘手术治疗后患者的生活质量不会改变。术前AM对于选择合适的手术方式很重要。
