Lykke Anna, Steendahl Joen, Wille-Jørgensen Peer A
Kirurgisk Afdeling K, Bispebjerg Hospital, DK-2400 København NV, Denmark.
Ugeskr Laeger. 2010 Feb 15;172(7):516-9.
The aim was to determine the incidence of anal incontinence, recurrence rate and patient satisfaction after using slow-cutting setons for transsphincteric anal fistula repair.
A retrospective study with prospective follow up in 58 patients who had undergone surgery for transsphincteric perianal fistulas with a slow-cutting seton. A total of 17 patients were excluded or lost in the follow up period. A questionnaire was send to 41 cases to the severity of incontinence for gas, liquid and stool according to the Wexner-score. Recurrence rate, sick leave and satisfaction with the treatment were estimated.
The questionnaire was returned from 34 patients. In all 23 men and 11 women had the seton tightened for the first time after a mean period of 32 days. The mean number of tightenings was five (range: 2-9). The mean duration of treatment was 256 days (range: 61-634). A total of four patients (12%) experienced recurrence. Twenty-one patients (61,7%) had a Wexner score of one or more. Eight patients (23,5%) scored more than four. A total of 28 patients (82%) were 75-100% satisfied with the treatment. Two patients (6%) were absolutely dissatisfied, and were considered failures. We found no association between the reported satisfaction with the treatment and the degree of incontinence.
Despite a very high level of satisfaction among the patients, the high rate of incontinence suggests that other non-invasive techniques should be used as first-line treatment of anal fistulas. In cases where multiple attempts at repair have failed, the slow-cutting seton may be the best option.
本研究旨在确定使用缓慢切割挂线治疗经括约肌肛瘘修复术后肛门失禁的发生率、复发率及患者满意度。
对58例行缓慢切割挂线治疗经括约肌肛周瘘管手术的患者进行回顾性研究，并进行前瞻性随访。共有17例患者在随访期间被排除或失访。向41例患者发放问卷，根据韦克斯纳评分评估气体、液体和粪便失禁的严重程度。评估复发率、病假时间及对治疗的满意度。
34例患者回复了问卷。所有患者中，23例男性和11例女性在平均32天后首次收紧挂线。平均收紧次数为5次（范围：2 - 9次）。平均治疗时间为256天（范围：61 - 634天）。共有4例患者（12%）复发。21例患者（61.7%）韦克斯纳评分为1分或更高。8例患者（23.5%）评分超过4分。共有28例患者（82%）对治疗的满意度为75% - 100%。2例患者（6%）完全不满意，被视为治疗失败。我们发现报告的治疗满意度与失禁程度之间无关联。
尽管患者满意度很高，但高失禁率表明其他非侵入性技术应作为肛瘘的一线治疗方法。在多次修复尝试失败的情况下，缓慢切割挂线可能是最佳选择。
