Buchanan G N, Owen H A, Torkington J, Lunniss P J, Nicholls R J, Cohen C R G
Department of Surgery, St Mark's Hospital, Northwick Park, Harrow, UK.
Br J Surg. 2004 Apr;91(4):476-80. doi: 10.1002/bjs.4466.
This study determined the long-term outcome after use of the loose-seton technique (LST) to eradicate complex fistula in ano.
Twenty patients whose complex fistula in ano was treated by the LST a minimum of 10 years previously were assessed by case-note review, supplemented where necessary by mailed and telephone interview.
Eighteen patients had a trans-sphincteric and two a suprasphincteric fistula. There were seven supralevator and 12 ischiorectal secondary extensions. At short-term follow-up, a median of 6 months following seton removal, perianal sepsis had been eradicated in 13 of 20 patients. However, the long-term success rate of the LST was lower than that noted in the short term (four versus 13 of 20). Sixteen patients had persisting or recurrent sepsis, necessitating further surgery in 13. In the long term, external sphincter division was necessary to control sepsis in seven of the 20 patients compared with three of 20 patients at short-term follow-up. The rate of relapse in those with Crohn's disease and cryptoglandular fistula in ano was similar (five of six versus 11 of 14; P = 1.000). The fistula recurred in seven, 11 and 15 patients at 6, 15 and 60 months respectively after seton removal.
The success rate of the LST for complex fistula in ano falls over time. Counselling before seton removal should emphasize that, although most patients do not require sphincter division and some are cured by this technique, many patients develop further sepsis that usually requires surgery.
本研究确定了采用挂线技术（LST）根除复杂性肛瘘后的长期疗效。
对至少在10年前接受LST治疗复杂性肛瘘的20例患者进行病例记录回顾评估，必要时通过邮寄和电话访谈进行补充。
18例患者为经括约肌肛瘘，2例为括约肌上肛瘘。有7例骨盆直肠间隙和12例坐骨直肠窝继发延伸。在短期随访中，即挂线拆除后中位6个月时，20例患者中有13例肛周脓毒症已根除。然而，LST的长期成功率低于短期记录的成功率（20例中4例对13例）。16例患者存在持续性或复发性脓毒症，其中13例需要进一步手术。长期来看，20例患者中有7例需要行外括约肌切断术来控制脓毒症，而短期随访时20例患者中有3例需要。克罗恩病患者和隐窝腺性肛瘘患者的复发率相似（6例中5例对14例中11例；P = 1.000）。挂线拆除后，分别在6、15和60个月时，7、11和15例患者肛瘘复发。
LST治疗复杂性肛瘘的成功率会随时间下降。在挂线拆除前进行咨询时应强调，尽管大多数患者不需要行括约肌切断术，且部分患者可通过该技术治愈，但许多患者会出现进一步的脓毒症，通常需要手术治疗。
