1Department of Surgery and Colorectal Surgery, Maastricht University Medical Center, Maastricht, The Netherlands 2Department of Surgery and Colorectal Surgery, Refaja Hospital, Stadskanaal, The Netherlands 3Department of Surgery and Colorectal Surgery, Atrium Medical Center Parkstad, Heerlen, The Netherlands.
Dis Colon Rectum. 2014 Feb;57(2):223-7. doi: 10.1097/DCR.0000000000000023.
The long-term closure rate of high perianal fistulas after surgical treatment remains disappointing.
The goal of this study was to improve the long-term closure rate of high cryptoglandular perianal fistulas combining mucosal advancement flap with platelet-rich plasma.
This study was retrospective in design.
This study was conducted at 2 secondary and 1 tertiary referral hospitals.
Patients presenting with high cryptoglandular perianal fistulas involving the middle/upper third of the anal sphincter complex were included.
A staged surgical treatment was performed; After seton placement, a mucosal advancement flap was combined with platelet-rich plasma.
Recurrence was the main outcome. Incontinence was the secondary outcome.
We operated on 25 patients between 2006 and 2012. Thirteen (52%) patients had previous fistula surgery. The median follow-up period was 27 months. One patient (4.0%) was lost to follow-up after 4 months. Freedom from recurrence at 2 years was 0.83 (95% CI, 0.62-0.93). Two of the 4 patients with a recurrence (8%) had a repeated treatment and healed. One patient (4.0%) refused another treatment, but agreed to stay in follow-up. One patient (4.0%) requested a colostomy, resulting in closure of the fistula. Complications occurred in 1 patient (4.0%). Incontinence numbers were low with a median Vaizey score of 3.0 out of a maximum of 24.
The study was limited by its retrospective design, lack of preoperative incontinence data, selection bias, and phone interview follow-up.
The long-term outcome results of patients with primary and recurrent high cryptoglandular perianal fistulas treated with a seton followed by mucosal advancement flap and platelet-rich plasma show low recurrence, complication, and incontinence rates. Therefore, this technique seems to be a valid option as treatment. Larger and preferably randomized controlled studies are needed to further explore this surgical technique.
高肛周瘘手术后的长期闭合率仍然令人失望。
本研究的目的是通过黏膜推进瓣联合富血小板血浆提高高位隐匿性肛旁瘘的长期闭合率。
本研究为回顾性设计。
本研究在 2 家二级和 1 家三级转诊医院进行。
纳入高隐窝性肛旁瘘患者，涉及肛门括约肌复合体的中/上部。
分期手术治疗；放置皮筋后，采用黏膜推进瓣联合富血小板血浆。
复发是主要观察指标，失禁是次要观察指标。
我们于 2006 年至 2012 年间对 25 例患者进行了手术。13 例（52%）患者有既往瘘管手术史。中位随访时间为 27 个月。1 例（4.0%）患者在 4 个月后失访。2 年无复发率为 0.83（95%CI，0.62-0.93）。4 例复发患者中的 2 例（8%）再次接受治疗并治愈。1 例（4.0%）患者拒绝再次治疗，但同意继续随访。1 例（4.0%）患者要求行结肠造口术，瘘管闭合。1 例（4.0%）患者出现并发症。失禁评分中位数为 3.0（最大 24 分），评分较低。
本研究为回顾性设计，缺乏术前失禁数据，存在选择偏倚，且仅通过电话访谈进行随访，存在一定局限性。
接受皮筋挂线后行黏膜推进瓣联合富血小板血浆治疗的初发性和复发性高位隐匿性肛旁瘘患者的长期结果显示复发率、并发症发生率和失禁率较低。因此，该技术似乎是一种有效的治疗选择。需要更大规模且最好为随机对照研究来进一步探索该手术技术。
