Loungnarath Rasmy, Dietz David W, Mutch Matthew G, Birnbaum Elisa H, Kodner Ira J, Fleshman James W
Section of Colon and Rectal Surgery, Washington University School of Medicine/Barnes-Jewish Hospital, St. Louis, Missouri, USA.
Dis Colon Rectum. 2004 Apr;47(4):432-6. doi: 10.1007/s10350-003-0076-8. Epub 2004 Feb 25.
Fibrin glue has been used to treat anal fistulas in an attempt to avoid more radical surgical intervention. Reported success rates vary widely. The purpose of this study was to review the use of fibrin glue in the management of complex anal fistulas at a tertiary referral center.
This study was designed as a retrospective review of all patients treated with fibrin glue injection for complex anal fistulas in the Section of Colon and Rectal Surgery, Washington University School of Medicine/Barnes-Jewish Hospital. Demographics, previous treatment, operative information, and early follow-up were obtained from the patients' medical records. Phone interviews were conducted to determine successful healing or recurrence of fistulas requiring further treatment. Statistical analysis was by Fisher's exact test. The institutional review board approved the study.
A total of 42 patients (19 males; median age, 44 (range, 20-76) years) were treated between 1999 and 2002. Three patients were lost to follow-up and were excluded from the study. Etiology of fistulas were cryptoglandular (n = 22), Crohn's disease (n = 13), or coloanal and ileal pouch-anal anastomotic (n = 4). Fistulas were classified as deep transsphincteric (n = 33), superficial transsphincteric (n = 1), supralevator (n = 2), or rectovaginal (n = 3). Initially, most patients had "closure" of the fistula but recrudescence was common. Durable healing was only achieved in 31 percent (12/39). Healing rates by etiology were cryptoglandular 23 percent (5/22), Crohn's disease 31 percent (4/13), and ileal pouch-anal anastomotic 75 percent (3/4; P = 0.14). Success rates by classification were deep transsphincteric 33 percent (11/33), superficial transsphincteric 0 percent (0/1), supralevator 0 percent (0/2), and rectovaginal 33 percent (1/3; P = 1). The success rate for patients with no previous treatment was 38 percent (8/21) vs. 22 percent (4/18) in those whose fistulas had been previously treated ( P = 0.32). Eight patients underwent a second fibrin glue treatment and only one of them healed (12.5 percent). Median follow-up for successfully healed fistula was 26 months.
Fibrin glue treatment for complex anal fistulas has a low success rate and most recrudescences occurred within three months. However, given the low morbidity and relative simplicity of the procedure, fibrin glue should still be considered as a first-line treatment for patients with complex anal fistulas.
纤维蛋白胶已被用于治疗肛瘘，试图避免更激进的手术干预。报道的成功率差异很大。本研究的目的是回顾在一家三级转诊中心使用纤维蛋白胶治疗复杂性肛瘘的情况。
本研究设计为对华盛顿大学医学院/巴恩斯-犹太医院结直肠外科接受纤维蛋白胶注射治疗复杂性肛瘘的所有患者进行回顾性研究。从患者的病历中获取人口统计学资料、既往治疗情况、手术信息和早期随访情况。通过电话访谈确定瘘管是否成功愈合或复发，是否需要进一步治疗。采用Fisher精确检验进行统计分析。机构审查委员会批准了该研究。
1999年至2002年期间共治疗了42例患者（19例男性；中位年龄44岁（范围20 - 76岁））。3例患者失访，被排除在研究之外。瘘管病因包括隐窝腺源性（n = 22）、克罗恩病（n = 13）或结肠肛管和回肠储袋肛管吻合口（n = 4）。瘘管分类为深部经括约肌型（n = 33）、浅部经括约肌型（n = 1）、括约肌上型（n = 2）或直肠阴道型（n = 3）。最初，大多数患者的瘘管“闭合”，但复发很常见。仅31%（12/39）的患者实现了持久愈合。按病因分类的愈合率为：隐窝腺源性23%（5/22）、克罗恩病31%（4/13）、回肠储袋肛管吻合口75%（3/4；P = 0.14）。按分类的成功率为：深部经括约肌型33%（11/33）、浅部经括约肌型0%（0/1）、括约肌上型0%（0/2）、直肠阴道型33%（1/3；P = 1）。未接受过先前治疗的患者成功率为38%（8/21），而先前接受过瘘管治疗的患者成功率为22%（4/18）（P = 0.32）。8例患者接受了第二次纤维蛋白胶治疗，其中仅1例愈合（12.5%）。成功愈合的瘘管的中位随访时间为26个月。
纤维蛋白胶治疗复杂性肛瘘的成功率较低，且大多数复发发生在三个月内。然而，鉴于该手术的低发病率和相对简单性，纤维蛋白胶仍应被视为复杂性肛瘘患者的一线治疗方法。
