Hammond T M, Knowles C H, Porrett T, Lunniss P J
Centre for Academic Surgery, Institute of Cellular and Molecular Science, The Royal London Hospital, Barts, London, UK.
Colorectal Dis. 2006 May;8(4):328-37. doi: 10.1111/j.1463-1318.2005.00926.x.
To assess the short and intermediate outcomes of a modification of the traditional cutting seton technique, using a 'snug' silastic seton, to treat idiopathic anal fistulae.
Between August 1997 and December 2002, 35 patients with idiopathic fistulae (4 female; age 26-76 years) underwent insertion of a 'snugly' tied 1 mm silastic seton (silicone nerve vessel retractor, Medasil), as definitive treatment. Short-term assessment was performed by case note review. Patients were subsequently invited to participate in a medium-term review.
Twenty-nine patients' notes (3 female) were available for short-term analysis. Fistulae were classified as intersphincteric (9) and transsphincteric (20). The seton spontaneously cut out in 15/29 (52%) after a median of 24 weeks. In 14 patients the seton enclosed residual tissue (< 5 mm) required division as a day case procedure, at a median of 35 weeks. All fistulae healed but 10/29 (34%) patients (1 female; 8 transsphincteric) experienced minor incontinence. Sixteen patients participated in a medium-term review at a median of 42 months; 7 had experienced early continence disturbance. No patient suffered recurrence, but minor incontinence persisted in 4/16 (25%) patients (0 females; 3 transsphincteric). All patients were at least 'satisfied' with the outcome.
In the short and medium term, the 'snug' seton is a safe and effective addition to the fistula surgeon's armamentarium.
评估采用“合适的”硅橡胶挂线对传统切割挂线技术进行改良后治疗特发性肛瘘的近期和中期疗效。
1997年8月至2002年12月期间，35例特发性肛瘘患者（4例女性；年龄26 - 76岁）接受了作为确定性治疗的“合适地”系紧的1毫米硅橡胶挂线（硅胶神经血管牵开器，Medasil）置入术。通过病历回顾进行短期评估。随后邀请患者参与中期复查。
有29例患者（3例女性）的病历可用于短期分析。肛瘘分为括约肌间型（9例）和经括约肌型（20例）。挂线在中位时间24周后有15/29（52%）自行脱落。14例患者的挂线包裹的残留组织（< 5毫米）需要作为日间手术进行切开，中位时间为35周。所有肛瘘均愈合，但10/29（34%）的患者（1例女性；8例经括约肌型）出现轻度失禁。16例患者参与了中位时间为42个月的中期复查；7例曾有早期控便障碍。无患者复发，但4/16（25%）的患者（0例女性；3例经括约肌型）仍存在轻度失禁。所有患者对治疗结果至少“满意”。
在近期和中期，“合适的”挂线是肛瘘外科医生治疗手段中一种安全有效的补充方法。
