Department of Colorectal Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
Dis Colon Rectum. 2010 Apr;53(4):486-95. doi: 10.1007/DCR.0b013e3181ce8b01.
Objectives of surgical treatment for transsphincteric and complex anorectal fistulas are the successful elimination of current/recurrent disease and the preservation of sphincter function. The concept of endorectal advancement flaps is to preserve the sphincter by closing off the primary opening by means of a mobilized flap. We performed a systematic review of the literature to assess the role of this technique.
A literature search on transanal rectal advancement flaps to treat cryptoglandular or Crohn fistula-in-ano was performed for the 30-year period between 1978 and 2008. Rectovaginal/rectourinary or cancer-related fistulas were excluded. Each study was examined for length of follow-up and the 2 major end points: success rate and incontinence rate.
From 35 studies with 2065 patients, we identified 1654 patients undergoing endorectal advancement flaps for cryptoglandular or Crohn disease. Four hundred eleven subjects were excluded (319 rectovaginal/rectourinary fistulas; 92 other causes). The quality of the reports was limited (low-level evidence) with numerous structural and design flaws. Weighted success and incontinence rates were 80.8%/13.2% for cryptoglandular and 64%/9.4% for Crohn fistulas.
Endorectal advancement flap is one tool, although not a perfect one, to treat complex anorectal fistulas of cryptoglandular or Crohn origin. Higher level evidence would be needed for comparison with other surgical techniques.
经括约肌和复杂性肛直肠瘘的外科治疗目的是成功消除当前/复发性疾病，并保留括约肌功能。经直肠内前伸皮瓣的概念是通过用可移动皮瓣关闭原发性开口来保留括约肌。我们对文献进行了系统回顾，以评估该技术的作用。
对 1978 年至 2008 年 30 年间经肛门直肠前伸皮瓣治疗隐窝腺或克罗恩性肛旁瘘的文献进行了检索。排除直肠阴道/直肠尿道或与癌症相关的瘘管。每个研究都检查了随访时间和 2 个主要终点：成功率和失禁率。
从 35 项研究的 2065 例患者中，我们确定了 1654 例接受经直肠内前伸皮瓣治疗隐窝腺或克罗恩病的患者。排除了 411 例（319 例直肠阴道/直肠尿道瘘；92 例其他原因）。报告的质量有限（低水平证据），存在许多结构和设计缺陷。隐窝腺瘘的加权成功率和失禁率分别为 80.8%/13.2%，克罗恩性瘘的成功率和失禁率分别为 64%/9.4%。
经直肠内前伸皮瓣是治疗隐窝腺或克罗恩性肛旁复杂性瘘的一种工具，但不是一种完美的工具。需要更高水平的证据来与其他手术技术进行比较。
