Kennedy H L, Zegarra J P
Department of Surgery, University of California, Davis, Sacramento.
Br J Surg. 1990 Aug;77(8):898-901. doi: 10.1002/bjs.1800770818.
Thirty-two patients with high trans-sphincteric or suprasphincteric fistulae underwent fistulotomy without external sphincter division. Fifteen patients had posterior fistulae involving the deep postanal space and 17 patients had anterior fistulae. Primary healing, after removal of the seton, occurred in 25 of the 32 patients (78 per cent). Primary healing in patients with posterior fistulae occurred in 66 per cent and in 88 per cent of patients with anterior fistulae. Following surgery, eight patients (33 per cent) reported problems controlling flatus, six patients (25 per cent) reported mucous discharge and one patient (4 per cent) complained of occasional incontinence for liquid stool. No patient experienced problems controlling solid stool nor did any patient require the use of a protective pad. These results have encouraged us to use this method as the initial procedure of choice for these more difficult fistulae. A significant number of patients can be cured of their fistula while preserving the external sphincter, thereby minimizing the impact of surgical therapy on continence.
32例患有经括约肌间或括约肌上肛瘘的患者接受了未切断外括约肌的瘘管切开术。15例患者为累及肛管后深间隙的后位肛瘘，17例患者为前位肛瘘。32例患者中有25例（78%）在拆除挂线后实现一期愈合。后位肛瘘患者的一期愈合率为66%，前位肛瘘患者的一期愈合率为88%。术后，8例患者（33%）报告有排气控制问题，6例患者（25%）报告有黏液排出，1例患者（4%）抱怨偶尔有液体粪便失禁。没有患者出现控制固体粪便的问题，也没有患者需要使用护垫。这些结果促使我们将这种方法作为这些较复杂肛瘘的首选初始治疗方法。大量患者可以在保留外括约肌的情况下治愈肛瘘，从而将手术治疗对控便能力的影响降至最低。
