Barillari Paolo, Basso Luigi, Larcinese Antonella, Gozzo Paolo, Indinnimeo Marileda
Department of Surgery "Pietro Valdoni", University of Rome "La Sapienza" Medical School, Policlinico "Umberto I", viale del Policlinico 155, 00161 Rome, Italy.
Int J Colorectal Dis. 2006 Dec;21(8):791-4. doi: 10.1007/s00384-006-0090-0. Epub 2006 Apr 20.
The management of anal fistula is debatable. Although several procedures have been described, none of them is free from complications, such as anal incontinence and anal pain. The purpose of this study was to evaluate the employment of a glue composed of N-butil-2-cyanoacrylate and methacryloxysulfolane (Glubran 2) to treat fistula-in-ano.
Twenty-one patients (14 men and 7 women) with cryptoglandular anal fistula were enrolled in the study and treated as day-cases. Fistulas were assessed both clinically and by trans-rectal endosonography with a rotating 10-MHz 360 degrees endoscopic probe. Assessment of continence was also performed. The fistula tract was identified, curetted and washed-out with normal saline and hydrogen peroxide; then the glue was injected from the syringe nozzle through a catheter previously inserted into the fistula. Additional treatments were performed when the first failed.
Five of seven simple fistulas (71.4%) healed with primary glue treatment; the other two needed second and third injections, and both healed. Ten of 14 (71.4%) complex fistulas healed with primary treatment; of the other four patients, one showed signs of intolerance to cyanoacrylate, which required re-intervention to remove the applied glue. In the second patient, treatment was successful after a second session; in the third case, three glue injections were required; while the fourth patient was lost at follow-up after three unsuccessful sessions. The ratio of cumulative healing with only one treatment was 15/21 (71.4%), and the ratio of overall healing after more than one session was 19/21 (90.2%). There was no sign of recurrence of the disease after 18 months of follow-up.
Cyanoacrylate glue seems to be ideal to treat fistula-in-ano, as it is a safe, cost-effective, repeatable and muscle-sparing technique. The incidence of recurrence is low, and post-procedure complicated fistulas or perianal abscesses were not reported.
肛瘘的治疗存在争议。尽管已描述了多种手术方法，但均无法避免诸如肛门失禁和肛门疼痛等并发症。本研究的目的是评估一种由N-丁基-2-氰基丙烯酸酯和甲基丙烯酰氧基环丁砜（Glubran 2）组成的胶水用于治疗肛瘘的效果。
21例（14例男性和7例女性）患有隐窝腺性肛瘘的患者纳入本研究并作为日间手术治疗。通过临床检查以及使用旋转式10MHz 360度内镜探头经直肠超声检查对肛瘘进行评估。同时也进行了控便能力评估。确定瘘管，刮除并使用生理盐水和过氧化氢冲洗；然后通过预先插入瘘管的导管从注射器喷嘴注入胶水。首次治疗失败时进行额外治疗。
7例简单肛瘘中有5例（71.4%）经初次胶水治疗后愈合；另外2例需要进行第二次和第三次注射，最终均愈合。14例复杂肛瘘中有10例（71.4%）经初次治疗愈合；另外4例患者中，1例显示对氰基丙烯酸酯不耐受迹象，需要再次干预以清除涂抹的胶水。第二例患者在第二次治疗后成功；第三例患者需要进行三次胶水注射；而第四例患者在三次治疗失败后失访。仅一次治疗后的累计愈合率为15/21（71.4%），一次以上治疗后的总体愈合率为19/21（90.2%）。随访18个月后无疾病复发迹象。
氰基丙烯酸酯胶水似乎是治疗肛瘘的理想方法，因为它是一种安全、经济有效、可重复且不损伤肌肉的技术。复发率低，且未报告术后复杂肛瘘或肛周脓肿。
