Uribe Natalia, Millán Monica, Minguez Miguel, Ballester Cristina, Asencio Francisco, Sanchiz Vicente, Esclapez Pedro, del Castillo Juan Ruiz
Department of Surgery, Arnau de Vilanova Hospital, Valencia, Spain.
Int J Colorectal Dis. 2007 Mar;22(3):259-64. doi: 10.1007/s00384-006-0172-z. Epub 2006 Aug 2.
Endorectal advancement flap repair is a well-recognized method for the treatment of complex anorectal fistula. The purpose of this study was to prospectively assess the clinical and functional results of endorectal advancement flaps for complex anorectal fistula and to identify factors that affect outcome.
A prospective study of 56 patients was performed. Clinical and functional results were studied using the Wexner continence scale and anal manometry before and after surgery. Factors associated with recurrence and incontinence were analyzed by univariate and multivariate regression analysis.
Sixty endorectal flaps were constructed in 56 patients. Mean age was 49 years (range 24-74). The fistula was of cryptoglandular origin in 91.1% cases. Mean follow-up was 43.8 months. The technique was repeated in four patients because of recurrence (7.1%), with subsequent healing in all cases. There were significant reductions in maximum resting pressure 3 months after surgery (83.6+/-33.2 vs 45.6+/-18.3, p<0.001) and maximum squeeze pressure (208.8+/-91.5 vs 169.5+/-75, p<0.001). Before surgery, five patients (8.9%) reported incontinence symptoms. After surgery, 78.6% patients had normal continence, seven patients (12.5%) complained of minor incontinence, and five (9%) had major continence disturbances. None of the variables studied (age, sex, previous fistula surgery, rectovaginal fistula, and Crohn's disease) affected the outcome of the procedure in multivariate analysis.
Endorectal advancement flap repair is an effective technique for complex anal fistula, with a low recurrence rate (7.1%). Patients (21.4%) reported disturbed anal continence. It is still not possible to identify factors that are predictive of failure or incontinence.
直肠推进皮瓣修复术是治疗复杂性肛瘘的一种公认方法。本研究的目的是前瞻性评估直肠推进皮瓣治疗复杂性肛瘘的临床和功能结果，并确定影响预后的因素。
对56例患者进行了前瞻性研究。使用韦克斯纳失禁量表和肛门测压法在手术前后研究临床和功能结果。通过单因素和多因素回归分析来分析与复发和失禁相关的因素。
56例患者共构建了60个直肠皮瓣。平均年龄为49岁（范围24 - 74岁）。91.1%的病例瘘管起源于隐窝腺。平均随访时间为43.8个月。4例患者（7.1%）因复发而重复该技术，所有病例随后均愈合。术后3个月最大静息压力（83.6±33.2 vs 45.6±18.3，p<0.001）和最大收缩压力（208.8±91.5 vs 169.5±75，p<0.001）均显著降低。术前，5例患者（8.9%）报告有失禁症状。术后，78.6%的患者控便正常，7例患者（12.5%）主诉轻度失禁，5例患者（9%）有严重控便障碍。在多因素分析中，所研究的变量（年龄、性别、既往肛瘘手术、直肠阴道瘘和克罗恩病）均未影响该手术的结果。
直肠推进皮瓣修复术是治疗复杂性肛瘘的有效技术，复发率低（7.1%）。21.4%的患者报告有肛门控便障碍。目前仍无法确定预测手术失败或失禁的因素。
