Qiang Leng, Hei-Ying Jin, National Center of Colorectal Surgery, the Third Affiliated Hospital of Nanjing University of Traditional Chinese Medicine, Nanjing 210001, Jiangsu Province, China.
World J Gastrointest Surg. 2012 Nov 27;4(11):256-61. doi: 10.4240/wjgs.v4.i11.256.
To investigate the efficacy of the anal fistula plug (AFP) compared to the mucosa advancement flap (MAF), considered the best procedure for patients with a complex anal fistula.
The literature search included PubMed, EMBASE, Cochrane Library and OVID original studies on the topic of AFP compared to MAF for complex fistula-in-ano that had a deadline for publication by April 2011. Randomized controlled trials, controlled clinical trials and prospective cohort studies were included in the review. After information collection, a meta-analysis was performed using data on overall success rates as well as incidence of incontinence and morbidity. The quality of postoperative life was also included with the clinical results.
Six studies involving 408 patients (AFP = 167, MAF = 241) were included in the meta-analysis. The differences in the overall success rates and incidence of fistula recurrence were not statistically significant between the AFP and MAF [risk difference (RD) = -0.12, 95%CI: -0.39 - 0.14; RD = 0.13; 95%CI: -0.18 - 0.43, respectively]. However, for the AFP, the risk of postoperative impaired continence was lower (RD = -0.08, 95%CI: -0.15 - -0.02) as was the incidence of other complications (RD = -0.06, 95%CI: -0.11 - -0.00). The postoperative quality of life, for patients treated using the AFP was superior to that of the MAF patients. Patients treated with the AFP had less persistent pain of a shorter duration and the healing time of the fistula and hospital stay were also reduced.
The AFP is an effective procedure for patients with a complex anal fistula; it has the same success rate but a lower risk of complications than the MAF and may also be associated with an improved postoperative quality of life. Additional evidence is needed to confirm these findings.
研究分析肛痿塞（AFP）与黏膜推进皮瓣（MAF）的疗效，MAF 被认为是治疗复杂肛痿的最佳方法。
文献检索包括 PubMed、EMBASE、Cochrane 图书馆和 OVID 对 AFP 与 MAF 治疗复杂肛痿的专题原始研究，截止日期为 2011 年 4 月。研究纳入了 AFP 与 MAF 治疗复杂肛痿的随机对照试验、对照临床试验和前瞻性队列研究。信息收集后，使用总体成功率以及失禁和发病率的数据进行了荟萃分析。术后生活质量也包括在临床结果中。
共有 6 项研究，涉及 408 例患者（AFP = 167，MAF = 241）被纳入荟萃分析。AFP 和 MAF 的总体成功率和痿复发率差异无统计学意义[风险差异（RD）=-0.12，95%CI：-0.39 - 0.14；RD = 0.13；95%CI：-0.18 - 0.43]。然而，AFP 的术后失禁风险较低（RD = -0.08，95%CI：-0.15 - -0.02），其他并发症的发生率也较低（RD = -0.06，95%CI：-0.11 - -0.00）。AFP 治疗患者的术后生活质量优于 MAF 治疗患者。AFP 治疗患者的持续性疼痛程度较轻、持续时间较短，痿的愈合时间和住院时间也较短。
AFP 是治疗复杂肛痿的有效方法；它与 MAF 具有相同的成功率，但并发症风险较低，也可能与术后生活质量的提高有关。需要更多的证据来证实这些发现。
