General Surgery Department, Colorectal Unit, Mansoura University Hospital, Elgomhoria street, Pox 35111, Mansoura, Egypt.
Int J Surg. 2010;8(4):321-5. doi: 10.1016/j.ijsu.2010.03.009. Epub 2010 Apr 11.
High transphincteric perianal fistula represents a technical challenge for surgical management. We compared the effects of partial rectal wall advancement flap versus the mucosal advancement flap in the treatment of high transphincteric perianal fistula in a randomized study in patients with anal fistula.
Consecutive patients treated for transphincteric anal fistula at our institution were evaluated for inclusion. Participants were randomly allocated to receive Group I: Fistulectomy, closure of internal sphincter and rectal advancement flap includes mucosa, submucosa, and circular muscle layer sutured 1 cm below the level of internal opening or Group II: The same as group one but the flap includes only mucosa and submucosa. Study variables included fistula closure rate, continence, morbidity, postoperative pain, hospital stay and quality of life.
Forty patients with high transphincteric perianal fistula were randomized and completed the study. Operative time was 31.6 +/- 6.8 min in group I, and 29.4 +/- 4.7 min in group II (P = 0.783). Hospital stay was significantly more in group 2 (96.35 +/- 9.5 vs. 105.8 +/- 13.23) (P = 0.014) Immediate postoperative complications, occurred in one patients (5%) exposed to disruption in group I and 6 patients (30%) in group II. Recurrence occurred in 2 patients (10%) in the group I and 8 patients (40%) in group II. Two patients (10%) in group I developed incontinence for flatus and no patients in the group II develop such complication.
Partial thickness advancement flap is better than mucosal advancement flap.
高位经括约肌肛痿对手术治疗来说是一个技术挑战。我们比较了部分直肠壁推进皮瓣与黏膜推进皮瓣在肛门痿患者中的治疗高位经括约肌肛痿的随机研究中的效果。
对在我院接受经括约肌肛痿治疗的连续患者进行评估以确定是否符合纳入标准。参与者被随机分配到接受以下治疗：组 I：瘘管切除术，内括约肌关闭，直肠推进皮瓣，包括黏膜、黏膜下层和环形肌层，缝合在内口下方 1cm 处；或组 II：与组 I 相同，但皮瓣仅包括黏膜和黏膜下层。研究变量包括痿管闭合率、控便能力、发病率、术后疼痛、住院时间和生活质量。
40 例高位经括约肌肛痿患者被随机分组并完成了研究。组 I 的手术时间为 31.6 +/- 6.8 分钟，组 II 为 29.4 +/- 4.7 分钟（P = 0.783）。组 2 的住院时间明显更长（96.35 +/- 9.5 比 105.8 +/- 13.23）（P = 0.014）。术后早期并发症，组 I 中有 1 例（5%）出现皮瓣撕裂，组 II 中有 6 例（30%）。组 I 中有 2 例（10%）复发，组 II 中有 8 例（40%）复发。组 I 中有 2 例（10%）患者出现排气失禁，组 II 中无患者出现这种并发症。
部分厚度推进皮瓣优于黏膜推进皮瓣。
