Toyonaga Takayuki, Matsushima Makoto, Kiriu Takashi, Sogawa Nobuhito, Kanyama Hiroki, Matsumura Naomi, Shimojima Yasuhiro, Hatakeyama Tomoaki, Tanaka Yoshiaki, Suzuki Kazunori, Tanaka Masao
Department of Surgery, Matsushima Hospital Colo-Proctology Center, 19-11 Tobehoncho, Yokohama, Japan.
Int J Colorectal Dis. 2007 Sep;22(9):1071-5. doi: 10.1007/s00384-007-0277-z. Epub 2007 Jan 30.
This study was undertaken to determine the incidence of and risk factors for anal incontinence after fistulotomy for intersphincteric fistula-in-ano. We also evaluated the role of anal manometry in preoperative assessment of intersphincteric fistula.
A prospective, observational study was undertaken in 148 patients who underwent fistulotomy for intersphincteric fistula between January and December 2004. Functional results were assessed by standard questionnaire and anal manometry. Possible factors predicting postoperative incontinence were examined by univariate and multivariate regression analyses.
The mean follow-up period was 12 months. Postoperative anal incontinence occurred in 30 patients (20.3%), i.e., soiling in 6, incontinence for flatus in 27, and incontinence for liquid stool in 4. Fistulotomy significantly decreased maximum resting pressure (85.9 +/- 20.4 to 60.2 +/- 18.4 mmHg, P < 0.0001) and length of the high pressure zone (3.92 +/- 0.69 to 3.82 +/- 0.77 cm, P = 0.035), but it did not affect voluntary contraction pressure (164.7 +/- 85.2 to 160.3 +/- 84.8 mmHg, P = 0.2792). Multivariate analysis showed low voluntary contraction pressure and multiple previous drainage surgeries to be independent risk factors for postoperative incontinence.
Fistulotomy produces a satisfactory outcome in terms of eradicating sepsis and preserving function in the vast majority of patients with intersphincteric fistula with intact sphincters. However, sphincter-preserving treatment may be advocated for patients with low preoperative voluntary contraction pressure or those who have undergone multiple drainage surgeries. Preoperative anal manometry is useful in determining the proper surgical procedure.
本研究旨在确定经括约肌间肛瘘切开术后肛门失禁的发生率及危险因素。我们还评估了肛门测压在括约肌间肛瘘术前评估中的作用。
对2004年1月至12月期间接受经括约肌间肛瘘切开术的148例患者进行了一项前瞻性观察研究。通过标准问卷和肛门测压评估功能结果。通过单因素和多因素回归分析检查预测术后失禁的可能因素。
平均随访期为12个月。30例患者（20.3%）出现术后肛门失禁，即6例有污粪，27例有排气失禁，4例有稀便失禁。肛瘘切开术显著降低了最大静息压力（从85.9±20.4 mmHg降至60.2±18.4 mmHg，P<0.0001）和高压区长度（从3.92±0.69 cm降至3.82±0.77 cm，P = 0.035），但不影响自主收缩压力（从164.7±85.2 mmHg降至160.3±84.8 mmHg，P = 0.2792）。多因素分析显示，自主收缩压力低和既往多次引流手术是术后失禁的独立危险因素。
对于绝大多数括约肌完整的经括约肌间肛瘘患者，肛瘘切开术在根除感染和保留功能方面产生了令人满意的结果。然而，对于术前自主收缩压力低或已接受多次引流手术的患者，可能提倡保留括约肌的治疗方法。术前肛门测压有助于确定合适的手术方式。
