Department of Surgery, Private Koru Hospital, Ankara, Turkey.
Tech Coloproctol. 2014 Feb;18(2):187-93. doi: 10.1007/s10151-013-1021-z. Epub 2013 Apr 30.
The aim of this study was to evaluate our experience in managing high anal fistulas with a simple modification of the cutting seton.
We performed a retrospective review of standardized patient charts and of prospectively collected scores and questionnaires. Surgical outcomes of 128 consecutive, well-documented patients with high anal fistulas, including anterior transsphincteric fistulas in females, treated using a hybrid seton, were analyzed.
No significant complications occurred. The mean postoperative pain scores on a visual analog scale were 3.23 and 0.61, on days 1 and 7, respectively. Complete healing was achieved in 67 cases (52.3 %) at 1 month and in all cases (100 %) at 3 months. Recurrent fistula was noted in 2 patients (1.5 %) at 6 and 12 months. The mean postoperative incontinence scores at 3 and 12 months did not differ significantly from the preoperative score (p = 0.061, Wilcoxon's test). The depression, life style, and embarrassment item scores of the fecal incontinence quality of life index improved significantly after surgical treatment.
The results of this series suggest that the hybrid seton might be a valid alternative for the treatment of high anal fistulas, eliminating the need for postoperative adjustments. The slow and stable cutting of the sphincter seems to have a positive effect on the maintenance of continence. The successful outcome is associated with significant improvement in quality of life.
本研究旨在评估我们在管理高位肛瘘方面的经验，方法是对切开挂线术进行简单的改良。
我们对 128 例经详细记录的高位肛瘘患者（包括女性前括约肌间瘘）的标准化患者病历和前瞻性收集的评分及问卷进行了回顾性分析，这些患者均采用混合挂线治疗。
无明显并发症发生。术后第 1 天和第 7 天的视觉模拟评分（VAS）分别为 3.23 和 0.61。1 个月时 67 例（52.3%）完全愈合，3 个月时所有患者（100%）完全愈合。2 例（1.5%）分别在术后 6 个月和 12 个月复发。术后 3 个月和 12 个月的失禁评分与术前相比无显著差异（p=0.061，Wilcoxon 检验）。粪便失禁生活质量指数的抑郁、生活方式和尴尬项目评分在手术后均显著改善。
本研究结果表明，混合挂线术可能是治疗高位肛瘘的一种有效替代方法，避免了术后调整的需要。括约肌缓慢而稳定的切开似乎对维持控便功能有积极作用。良好的治疗效果与生活质量的显著改善相关。
