经肛门推进皮瓣修复术治疗高位经括约肌肛瘘术后预后的预测因素
Predictors of outcome after transanal advancement flap repair for high transsphincteric fistulas.
作者信息
van Onkelen Robbert S, Gosselink Martijn P, Thijsse Sjoerd, Schouten Willem R
机构信息
1Department of Surgery, Erasmus MC, University Medical Center, Rotterdam, the Netherlands 2Department of Immunology, Erasmus MC, University Medical Center, Rotterdam, the Netherlands 3Department of Surgery, Oxford University Hospitals, Oxford, United Kingdom.
出版信息
Dis Colon Rectum. 2014 Aug;57(8):1007-11. doi: 10.1097/DCR.0000000000000154.
BACKGROUND
Transanal advancement flap repair fails in 1 of every 3 patients with a high transsphincteric fistula. It has been reported that smoking, obesity, and previous attempts at repair adversely affect the outcome of transanal advancement flap repair. Because these findings could not be confirmed by other studies, it is still unclear whether these and other factors have an impact on the outcome.
OBJECTIVE
The aim of this study was to identify predictors of outcome in a large cohort of patients who underwent transanal advancement flap repair for a high transsphincteric fistula.
DESIGN
This study was performed as a retrospective review.
SETTINGS
The study was conducted at the Division of Colon and Rectal Surgery, Erasmus MC, between 2000 and 2012.
PATIENTS
A consecutive series of 252 patients with a high transsphincteric fistula of cryptoglandular origin were included. Patients with a rectovaginal or Crohn fistula were excluded.
INTERVENTIONS
All patients underwent transanal advancement flap repair. Preoperatively, patients underwent endoanal MRI.
MAIN OUTCOME MEASURES
Healing was defined as complete wound healing with absence of symptoms. Patients were followed up to assess failure. Seventeen patient- and fistula-related variables were assessed.
RESULTS
Median duration of follow-up was 21 months (range, 6-136 months). The failure rate at 3 years was 41% (95% CI, 34-48). None of the studied variables predicted the outcome of flap repair except horseshoe extension. In univariate and multivariate analyses, significantly less failures were observed in patients with a horseshoe extension (p < 0.05).
LIMITATIONS
Retrospective design, a single surgeon series, and potential selection bias caused by the tertiary referral center status are the limitations of this study.
CONCLUSIONS
Of all studied variables, horseshoe extension was found to be the only positive predictor of outcome after flap repair for high transsphincteric fistulas.
背景
经肛门推进皮瓣修复术治疗高位经括约肌肛瘘，每3例患者中就有1例失败。据报道，吸烟、肥胖以及既往修复尝试会对经肛门推进皮瓣修复术的结果产生不利影响。由于这些发现未得到其他研究的证实，目前尚不清楚这些因素及其他因素是否会对结果产生影响。
目的
本研究旨在确定一大群接受经肛门推进皮瓣修复术治疗高位经括约肌肛瘘患者的预后预测因素。
设计
本研究为回顾性研究。
地点
该研究于2000年至2012年在伊拉斯姆斯医学中心结直肠外科进行。
患者
纳入252例连续性高位经括约肌腺源性肛瘘患者。排除直肠阴道瘘或克罗恩瘘患者。
干预措施
所有患者均接受经肛门推进皮瓣修复术。术前，患者接受肛管内磁共振成像检查。
主要观察指标
愈合定义为伤口完全愈合且无症状。对患者进行随访以评估失败情况。评估了17个患者和瘘管相关变量。
结果
中位随访时间为21个月（范围6 - 136个月）。3年时的失败率为41%（95%CI，34 - 48）。除马蹄形延伸外，所研究的变量均未预测皮瓣修复的结果。在单因素和多因素分析中，马蹄形延伸的患者失败率显著较低（p < 0.05）。
局限性
回顾性设计、单一外科医生系列以及三级转诊中心地位导致的潜在选择偏倚是本研究的局限性。
结论
在所有研究变量中，马蹄形延伸是高位经括约肌肛瘘皮瓣修复术后唯一的预后阳性预测因素。
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