Charúa-Guindic Luis, Méndez-Morán Maxi Alexander, Avendaño-Espinosa Octavio, Jiménez-Bobadilla Billy, Charúa-Levy Elias
Academia Mexicana de Cirugía, Jefe de la Universidad de Coloproctología, Servicio de Gastroenterología, Hospital General de México, Facultad de Medicina, Universidad Nacional Autónoma de México.
Cir Cir. 2007 Sep-Oct;75(5):351-6.
Anorectal sepsis is a frequent condition presenting in the office of colorectal specialists. The acute phase presents as an abscess and the chronic phase as a fistula. We undertook this study to report the experience of the Coloproctology Unit of the General Hospital of Mexico in the management of complex anal fistula with cutting seton.
From May 1999 to April 2004, 11,731 clinical cases were reviewed. Inclusion criteria were patients with complex anal fistula treated using the cutting seton technique and 6 months minimum follow-up after withdrawal of seton.
There were 742 fistulous patients among which 50 fulfilled inclusion criteria. There were 44 males and 6 females. Fistulas were classified as high transsphincteric in 41 patients, suprasphincteric in 8 patients, and high intersphincteric in one patient. On average, patients were followed-up during 9.67 postoperative examinations and on average there were 4.55 adjustments. The average permanence of seton was 7.02 months.
Management of complex anal fistula continues to be a challenge for surgeons. Cutting seton is an appropriate surgical option for patients with no alteration of continence and is useful for patients with high transsphincteric, suprasphincteric and, in some cases, extrasphincteric fistula. In women with low anterior transsphincteric fistula, this option must be considered as an alternative.
肛肠脓毒症是结直肠专科医生门诊中常见的病症。急性期表现为脓肿，慢性期表现为肛瘘。我们开展这项研究以报告墨西哥总医院结直肠科在使用切割挂线疗法治疗复杂性肛瘘方面的经验。
回顾了1999年5月至2004年4月期间的11731例临床病例。纳入标准为采用切割挂线技术治疗的复杂性肛瘘患者，且在拆除挂线后至少随访6个月。
共有742例肛瘘患者，其中50例符合纳入标准。男性44例，女性6例。41例患者的肛瘘分类为高位经括约肌型，8例为括约肌上型，1例为高位括约肌间型。患者平均接受了9.67次术后检查，平均进行了4.55次调整。挂线的平均留置时间为7.02个月。
复杂性肛瘘的治疗对外科医生来说仍然是一项挑战。切割挂线疗法对于控便功能未受影响的患者是一种合适的手术选择，对高位经括约肌型、括约肌上型以及某些情况下的括约肌外型肛瘘患者有用。对于低位前位经括约肌型肛瘘的女性患者，该选择可作为一种替代方案。
