Eitan A, Duek D S, Barzilai A
Dept. of Surgery A, Rambam Medical Center, Haifa.
Harefuah. 1990 Sep;119(5-6):134-6.
In most patients anal fistulas are of the intersphincteric type (Parks' classification). Treatment consists of simple fistulotomy. 10% of those with an anal fistula have the more complicated trans-sphincteric type. The treatment of such a fistula by primary fistulotomy is associated with a high rate of incontinence. A technique to avoid this complication is the use of the seton for gradual transection of the sphincteric fibers. 21 of 53 patients with anal fistula had a trans-sphincteric fistula, and all of them were treated with setons. Hospital stay was 2 days and was followed by 2-4 outpatient visits. 17 patients (85%) underwent the procedure without any complications and were cured. 3 (15%) had minor problems with continence, of whom 2 required emergency operation. In no case did the fistula recur. We find that the use of the seton after partial fistulotomy for complicated anal fistulas reduces the rate of incontinence caused by sphincteric transection and has a very low recurrence rate.
在大多数患者中，肛瘘属于括约肌间型（帕克分类法）。治疗方法为单纯肛瘘切开术。10%的肛瘘患者患有更为复杂的经括约肌型。对这种肛瘘进行一期肛瘘切开术治疗会导致较高的失禁发生率。一种避免这种并发症的技术是使用挂线逐步切断括约肌纤维。53例肛瘘患者中有21例患有经括约肌型肛瘘，他们全部接受了挂线治疗。住院时间为2天，之后还需进行2至4次门诊复诊。17例患者（85%）手术过程无任何并发症且治愈。3例（15%）出现轻微的控便问题，其中2例需要急诊手术。无一例肛瘘复发。我们发现，对于复杂肛瘘，在部分肛瘘切开术后使用挂线可降低括约肌切断所致的失禁发生率，且复发率极低。
