van Onkelen R S, Gosselink M P, van Rosmalen J, Thijsse S, Schouten W R
Department of Surgery, Erasmus MC, University Medical Centre, Rotterdam, The Netherlands; Department of Immunology, Erasmus MC, University Medical Centre, Rotterdam, The Netherlands.
Colorectal Dis. 2014 Jun;16(6):471-5. doi: 10.1111/codi.12578.
Transsphincteric fistulae are classified as high or low. The aim of this observational study was to determine whether or not they have different characteristics.
A consecutive series of 300 patients with a transsphincteric fistula of cryptoglandular origin was studied. Two hundred patients with a high transsphincteric fistula underwent transanal advancement flap repair and 100 patients with a low transsphincteric fistula underwent fistulotomy or ligation of the intersphincteric fistula tract at the Division of Colon and Rectal Surgery, Erasmus MC, Rotterdam. Various patient and fistula characteristics were assessed. Data were analysed by means of logistic regression.
Low transsphincteric fistulae occurred more frequently in females (43% low transsphincteric fistulae vs 30% high transsphincteric fistulae; P < 0.05). The internal opening of these fistulae was predominantly located anteriorly (76% vs 18% in high transsphincteric fistulae; P < 0.001). Mean age at surgery was lower in patients with a low transsphincteric fistula (42 vs 47 years; P < 0.001). In these patients an associated abscess was observed in 4% compared with 54% of those patients with a high transsphincteric fistula (P < 0.001). In multivariate analysis, the differences between high and low transsphincteric fistulae regarding location of their internal opening and the presence of associated abscesses remained significant (P < 0.001).
Although not significant in multivariate analysis, low transsphincteric fistulae occur more frequently in younger patients and more often in females. These fistulae are predominantly located anteriorly and are rarely associated with an abscess. This was significant in univariate and multivariate analysis.
经括约肌肛瘘分为高位或低位。本观察性研究的目的是确定它们是否具有不同的特征。
对连续300例腺源性经括约肌肛瘘患者进行研究。200例高位经括约肌肛瘘患者在鹿特丹伊拉斯姆斯医学中心结直肠外科接受经肛门推进皮瓣修复术，100例低位经括约肌肛瘘患者接受瘘管切开术或括约肌间瘘管结扎术。评估了各种患者和肛瘘特征。采用逻辑回归分析数据。
低位经括约肌肛瘘在女性中更常见（低位经括约肌肛瘘占43%，高位经括约肌肛瘘占30%；P<0.05）。这些肛瘘的内口主要位于前方（76%，而高位经括约肌肛瘘为18%；P<0.001）。低位经括约肌肛瘘患者的手术平均年龄较低（42岁对47岁；P<0.001）。在这些患者中，4%观察到伴有脓肿，而高位经括约肌肛瘘患者为54%（P<0.001）。在多变量分析中，高位和低位经括约肌肛瘘在内口位置和是否存在相关脓肿方面的差异仍然显著（P<0.001）。
尽管在多变量分析中不显著，但低位经括约肌肛瘘在年轻患者中更常见，在女性中更频繁出现。这些肛瘘主要位于前方，很少伴有脓肿。这在单变量和多变量分析中均具有显著性。
