Mishra Atul, Shah Sheerin, Nar Amandeep Singh, Bawa Ashvind
Professor, Department of Surgery.
J Clin Diagn Res. 2013 May;7(5):876-9. doi: 10.7860/JCDR/2013/5387.2964. Epub 2013 May 1.
The aim of this study was to assess the outcome of fibrin glue in high and low anal fistulas.
A prospective, non-randomized trial was carried out on 30 patients who were diagnosed to have fistulas in ano. They were evaluated by categorizing them into high (with the internal opening above the anorectal ring)(14/30) and low anal fistulas (with the internal opening below the anorectal ring)(16/30). The fibrin glue was instilled in their anal tracts. The character of the anal tract, whether it was single or multiple and primary or recurrent, was analyzed. The outcome in terms of a postoperative discharge (failure), the incidence of a postoperative perianal pain/abscess and the glue reaction, was noted at 1 week, 1 month, 3 months and 6 months. A success was defined as the absence of any discharge at 6 months.
Fourteen patients with high anal fistulas and 16 with low anal fistulas (with a mean age of 48.5yrs) were treated with fibrin glue. 19 patients had primary tracts (7- high group and 12- low group) and 11 had recurrent tracts (7- high group and 4- low group). 20 fistulas were single tracted (8- high and 12- low) and ten were multiple tracted (6- high and 4-low). The success rate at 6 months was 57.14% in the high group and it was 81.25% in the low group. The failure rate was 85.71% in the recurrent high fistula group as compared to 25% in the recurrent low fistula group (p=0.049). 25% of the single tracted high fistulas failed to heal as compared to a 100% healing rate in the single low fistulas group (p=0.90).
This procedure is thus, superior to the conventional surgical treatment, in terms of the patient comfort, an undisturbed sphincter function, a reduced overall hospital stay, wound pain and the complications and adverse reactions. It showed the best results in the primary, single tracted and the low anal fistulas.
本研究旨在评估纤维蛋白胶治疗高位和低位肛瘘的效果。
对30例诊断为肛瘘的患者进行了一项前瞻性、非随机试验。通过将他们分为高位肛瘘（内口在肛管直肠环上方）（14/30）和低位肛瘘（内口在肛管直肠环下方）（16/30）进行评估。将纤维蛋白胶注入他们的肛管。分析肛管的特征，是单发性还是多发性，原发性还是复发性。在术后1周、1个月、3个月和6个月记录术后引流情况（失败）、术后肛周疼痛/脓肿的发生率以及胶水反应。成功定义为6个月时无任何引流。
14例高位肛瘘患者和16例低位肛瘘患者（平均年龄48.5岁）接受了纤维蛋白胶治疗。19例患者为原发性瘘管（7例在高位组，12例在低位组），11例为复发性瘘管（7例在高位组，4例在低位组）。20例肛瘘为单发性（8例在高位组，12例在低位组），10例为多发性（6例在高位组，4例在低位组）。高位组6个月时的成功率为57.14%，低位组为81.25%。复发性高位肛瘘组的失败率为85.71%，而复发性低位肛瘘组为25%（p = 0.049）。单发性高位肛瘘中有25%未能愈合，而单发性低位肛瘘组的愈合率为100%（p = 0.90）。
因此，就患者舒适度、括约肌功能不受干扰、总体住院时间缩短、伤口疼痛以及并发症和不良反应而言，该手术优于传统手术治疗。它在原发性、单发性和低位肛瘘中显示出最佳效果。
