Maralcan Göktürk, Başkonuş Ilyas, Aybasti Necdet, Gökalp Avni
Department of General Surgery, Faculty of Medicine, Gaziantep University, Gaziantep, Turkey.
Surg Today. 2006;36(2):166-70. doi: 10.1007/s00595-005-3121-5.
This prospective study was done to analyze the efficacy of commercial fibrin glue application in the healing of patients with fistulas-in-ano.
This clinical trial of 36 patients was performed during the period from November 2003 to May 2004. Thirty men and six women were treated for a fistula-in-ano with commercial fibrin glue application. None of the patients had undergone prior attempts to correct fistulas-in-ano surgically. All patients received preoperative mechanical bowel preparation and prophylactic intravenous antibiotics. In the operating room, the patients underwent an anorectal examination under spinal anesthesia. The external and internal fistula tract openings were then identified. The fistula tract was curetted. Fibrin glue was injected into the external fistula opening until fibrin glue could be seen coming from the internal opening. No dressing was applied over the external opening. Thereafter, the patient was discharged. A 1-week course of oral antibiotics was prescribed. The patients were followed up for 70 weeks with a mean of 54 weeks (range 40-70 weeks).
The cause of the fistula-in-ano was cryptoglandular in all patients. The overall initial success rate was 77.8% (28/36). No complications were encountered related to the application. Two patients underwent a reapplication with fibrin glue and the fistulas of these patients were all closed. The overall success rate was 83.3% (30/36).
Fibrin glue application was thus found to be an easy, safe, effective, and useful alternative treatment in the management of fistulas-in-ano. However, our findings need substantiation by increasing the number of patients and prolonging the follow-up duration, as well as carrying out comparative studies.
本前瞻性研究旨在分析商用纤维蛋白胶在肛瘘患者愈合中的疗效。
本临床试验于2003年11月至2004年5月期间对36例患者进行。30名男性和6名女性接受了商用纤维蛋白胶治疗肛瘘。所有患者此前均未尝试过手术矫正肛瘘。所有患者均接受术前机械肠道准备和预防性静脉抗生素治疗。在手术室，患者在脊髓麻醉下接受肛肠检查。然后确定外瘘口和内瘘口。刮除瘘管。将纤维蛋白胶注入外瘘口，直到看到纤维蛋白胶从内口流出。外口不覆盖敷料。此后，患者出院。开了为期1周的口服抗生素疗程。对患者进行了70周的随访，平均随访54周（范围40 - 70周）。
所有患者肛瘘的病因均为腺源性。总体初始成功率为77.8%（28/36）。未遇到与应用相关的并发症。2例患者再次应用纤维蛋白胶，这些患者的瘘管均闭合。总体成功率为83.3%（30/36）。
因此，发现应用纤维蛋白胶是肛瘘治疗中一种简便、安全、有效且有用的替代治疗方法。然而，我们的研究结果需要通过增加患者数量、延长随访时间以及进行对比研究来加以证实。
