Wang Jennifer Y, Garcia-Aguilar Julio, Sternberg Jeffrey A, Abel Michael E, Varma Madhulika G
Department of Surgery, University of California, San Francisco, San Francisco, California, USA.
Dis Colon Rectum. 2009 Apr;52(4):692-7. doi: 10.1007/DCR.0b013e31819d473f.
Treatments for transsphincteric, cryptoglandular anal fistulas pose risks for high recurrence rates and impaired anal continence. Anal fistula plugs have gained popularity because of reports of success without compromising the anal sphincter. To examine the benefit of the anal fistula plug, we compared its success rate with a standard treatment for transsphincteric fistulas with similar indications, the transanal mucosal advancement flap.
We examined the outcomes of all patients with transsphincteric fistulas who underwent anal fistula plug repair from July 2005 to December 2006, excluding those with Crohn's disease or less than three months of follow-up. They were compared with a historical control group of patients (2001-2005) with similar transsphincteric fistulas who underwent a transanal mucosal advancement flap procedure because the anal fistula plug was not available. The same surgeons performed both procedures. Outcome was assessed from medical records or telephone follow-up.
Twenty-nine patients underwent an anal fistula plug repair, and 26 patients underwent a flap procedure. Fistula closure rates were 34 percent for plugs and 62 percent for flaps (P = 0.045). The groups were similar in all respects except that 3 percent of plug patients and 58 percent of flap patients had postoperative inpatient stays and the median follow-up was longer (279 vs. 819 days) for the flap group.
Fistula closure rates were significantly lower with anal fistula plugs than with advancement flaps. Although the low success rates for fistula plugs could be a result of patient selection, more data needs to be accrued before fistula plugs can be recommended as definitive first-line treatment for transsphincteric fistulas.
经括约肌间型、隐窝腺性肛瘘的治疗存在高复发率和肛门节制功能受损的风险。肛瘘栓因其在不损害肛门括约肌的情况下取得成功的报道而受到欢迎。为了研究肛瘘栓的益处，我们将其成功率与具有相似适应症的经括约肌间型肛瘘的标准治疗方法——经肛门黏膜推进瓣进行了比较。
我们研究了2005年7月至2006年12月期间所有接受肛瘘栓修复的经括约肌间型肛瘘患者的结局，排除患有克罗恩病或随访时间少于三个月的患者。将他们与一组历史对照组患者（2001 - 2005年）进行比较，这些患者患有相似的经括约肌间型肛瘘，因当时没有肛瘘栓而接受了经肛门黏膜推进瓣手术。两种手术均由相同的外科医生进行。通过病历或电话随访评估结局。
29例患者接受了肛瘘栓修复，26例患者接受了推进瓣手术。肛瘘栓的闭合率为34%，推进瓣的闭合率为6%（P = 0.045）。除了3%的肛瘘栓患者和58%的推进瓣患者术后有住院治疗，且推进瓣组的中位随访时间更长（279天对819天）外，两组在各方面均相似。
肛瘘栓的肛瘘闭合率明显低于推进瓣。尽管肛瘘栓的低成功率可能是患者选择的结果，但在肛瘘栓可被推荐作为经括约肌间型肛瘘的确切一线治疗方法之前，还需要积累更多数据。
