经括约肌间瘘管结扎术与推移皮瓣术治疗需要初次挂线引流的复杂性肛直肠瘘
Ligation of intersphincteric fistula tract compared with advancement flap for complex anorectal fistulas requiring initial seton drainage.
机构信息
Department of Surgery School of Medicine, Townsville and the Australian Institute of Tropical Medicine, North Queensland Centre for Cancer Research, James Cook University, Townsville, Queensland, Australia.
出版信息
Am J Surg. 2012 Sep;204(3):283-9. doi: 10.1016/j.amjsurg.2011.10.025. Epub 2012 May 19.
BACKGROUND
The ligation of intersphincteric fistula tract (LIFT) is a relatively new surgical technique for treating complex anorectal fistulas.
METHODS
LIFT was compared with anorectal advancement flap management (ARAF) of complex anorectal fistulas requiring previous seton drainage. Crohn's patients were excluded. Patients with no confirmed recurrent sepsis after 6 months were randomized to day surgery performance of LIFT (25; 17 male) or ARAF (14; 10 male) with removal of the seton. Outcome measures included recurrences, surgical time, complications, hospital readmissions, and fecal incontinence.
RESULTS
LIFT was 32.5 minutes shorter than ARAF (P < .001). Complications were similar, with no hospital readmissions. Return to normal activities was 1 week for LIFT patients, 2 weeks for ARAF patients (P = .016). At 19 months there were 3 recurrences (2 in the LIFT group). One ARAF patient had minor incontinence.
CONCLUSIONS
The LIFT procedure was simple, safe, shorter, and patients returned to work earlier. All patients had preliminary seton drainage, possibly contributing to the low recurrence rates.
背景
括约肌间瘘管结扎术（LIFT）是一种治疗复杂性肛直肠瘘的相对较新的手术技术。
方法
比较 LIFT 与需要先前挂线引流的复杂性肛直肠瘘的肛直肠推进皮瓣管理（ARAF）。排除克罗恩病患者。6 个月后无确认复发性脓毒症的患者随机分为日间手术 LIFT（25 例；17 名男性）或 ARAF（14 例；10 名男性），并取出挂线。观察指标包括复发、手术时间、并发症、住院再入院和粪便失禁。
结果
LIFT 比 ARAF 短 32.5 分钟（P<0.001）。并发症相似，无住院再入院。LIFT 患者的恢复正常活动时间为 1 周，ARAF 患者为 2 周（P=0.016）。19 个月时有 3 例复发（LIFT 组 2 例）。1 例 ARAF 患者有轻微失禁。
结论
LIFT 操作简单、安全、用时更短，患者更早恢复工作。所有患者均接受初步挂线引流，这可能有助于降低复发率。
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