Ellis C Neal
Department of Surgery, University of South Alabama, Mobile, AL 36617, USA.
J Surg Educ. 2007 Jan-Feb;64(1):36-40. doi: 10.1016/j.cursur.2006.07.005.
The goal in the treatment of anal fistulas is to eliminate the fistula without a change in continence. No single technique exists that is appropriate for the treatment of all fistulas. Options include fistulotomy, use of setons, fibrin sealant, and advancement flaps. Recently, a bioprosthetic fistula plug has been described. The purpose of this study is to report the author's early experience with the bioprosthetic fistula plug and to compare the results of bioprosthetic plug closure of complex anal fistulas with those achieved with advancement flap repair.
A retrospective analysis of prospectively collected data was performed for patients treated with an anal fistula. Data collected included age, gender, fistula anatomy and etiology, previous repairs, comorbidities, procedure performed, pain scores, and fistula recurrence.
Overall, 95 patients comprised the control group (43 men and 52 women), with transsphincteric or rectovaginal fistulas in 51 and 44 patients, respectively, managed by advancement flap repair of their fistula. The fistula recurred in 31 patients (32.6%) during a median follow-up of 10 months. Overall,18 patients had their fistula managed using the porcine fistula plug (12 men and 6 women), with transsphincteric or rectovaginal fistulas in 13 and 5 patients, respectively. The fistula recurred in 2 patients (12%) during a median follow-up of 6 months.
Use of a porcine fistula plug for the management of complex anal fistulas is a new technique that, in the early experience, seems to yield results similar to advancement flap repair.
肛瘘治疗的目标是消除瘘管且不改变控便能力。不存在适用于所有肛瘘治疗的单一技术。治疗选择包括瘘管切开术、挂线疗法、纤维蛋白粘合剂和推进皮瓣。最近，一种生物假体肛瘘塞已被报道。本研究的目的是报告作者使用生物假体肛瘘塞的早期经验，并比较生物假体塞闭合复杂性肛瘘与推进皮瓣修复的结果。
对前瞻性收集的肛瘘治疗患者数据进行回顾性分析。收集的数据包括年龄、性别、瘘管解剖结构和病因、既往修复情况、合并症、所实施的手术、疼痛评分和瘘管复发情况。
总体而言，95例患者组成对照组（43例男性和52例女性），其中51例和44例分别为经括约肌肛瘘或直肠阴道瘘，采用推进皮瓣修复瘘管。在中位随访10个月期间，31例患者（32.6%）瘘管复发。总体而言，18例患者使用猪肛瘘塞治疗瘘管（12例男性和6例女性），其中13例和5例分别为经括约肌肛瘘或直肠阴道瘘。在中位随访6个月期间，2例患者（12%）瘘管复发。
使用猪肛瘘塞治疗复杂性肛瘘是一种新技术，在早期经验中，其效果似乎与推进皮瓣修复相似。
