Damin Daniel C, Rosito Mário A, Contu Paulo C, Tarta Cláudio
Division of Coloproctology, Hospital de Clinicas de Porto Alegre, Porto Alegre, RS, Brazil.
Arq Gastroenterol. 2009 Oct-Dec;46(4):300-3. doi: 10.1590/s0004-28032009000400010.
Management of complex anal fistulas is associated with the risk of sphincter injury and fecal incontinence. In recent years, fibrin glue has emerged as an alternative sphincter-preserving treatment for anal fistulas. To date, however, there is no consensus about the efficacy of the method.
To specifically evaluate the fibrin glue injection in the management of complex cryptoglandular anal fistulas.
We studied a series of patients with complex anal fistulas treated with fibrin glue between January 2005 and January 2007. Only patients with fistulas of cryptoglandular origin were analyzed. Patients with fistulas related to Crohn's disease, HIV or previous surgery were excluded from the study. Under spinal anesthesia, the fistulas were curetted and injected with fibrin glue. After treatment, patients were followed-up for 12 months.
Thirty-two patients were enrolled in the study. Two patients were lost to follow-up and were excluded. Out of the remaining 30 patients, only three healed successfully (10%). Among the 27 patients who failed to heal, 9 (33.3%) were diagnosed within the first postoperative month. In 13 patients (48.1%) the failure of treatment occurred in the period between 1 and 3 months, in 3 patients (11.1%) between 3 and 6 months, and in 2 patients (7.4%) between 6 and 9 months after surgery. No treatment-related complications were observed.
In this series, fibrin glue treatment for complex cryptoglandular anal fistulas achieved a very low healing rate. Our results do not support the use of fibrin glue as a first-line treatment for patients with this type of fistula.
复杂肛瘘的治疗存在括约肌损伤和大便失禁的风险。近年来，纤维蛋白胶已成为一种用于肛瘘的保留括约肌的替代治疗方法。然而，迄今为止，对于该方法的疗效尚无共识。
具体评估纤维蛋白胶注射治疗复杂隐窝腺性肛瘘的效果。
我们研究了2005年1月至2007年1月期间接受纤维蛋白胶治疗的一系列复杂肛瘘患者。仅分析隐窝腺源性肛瘘患者。与克罗恩病、HIV或既往手术相关的肛瘘患者被排除在研究之外。在脊髓麻醉下，刮除瘘管并注射纤维蛋白胶。治疗后，对患者进行12个月的随访。
32例患者纳入研究。2例患者失访并被排除。在其余30例患者中，仅3例成功愈合（10%）。在27例未愈合的患者中，9例（33.3%）在术后第一个月内被诊断。13例患者（48.1%）在1至3个月期间治疗失败，3例患者（11.1%）在3至6个月期间，2例患者（7.4%）在术后6至9个月期间。未观察到与治疗相关的并发症。
在本系列研究中，纤维蛋白胶治疗复杂隐窝腺性肛瘘的愈合率非常低。我们的结果不支持将纤维蛋白胶用作这类肛瘘患者的一线治疗方法。
