Pommaret E, Benfredj P, Soudan D, de Parades V
Service de proctologie médico-chirurgicale, groupe hospitalier Paris Saint-Joseph, institut Léopold-Bellan, 185, rue Raymond-Losserand, 75014 Paris, France.
Service de proctologie médico-chirurgicale, groupe hospitalier Paris Saint-Joseph, institut Léopold-Bellan, 185, rue Raymond-Losserand, 75014 Paris, France.
J Visc Surg. 2015 Apr;152(2 Suppl):S31-6. doi: 10.1016/j.jviscsurg.2014.08.002. Epub 2014 Oct 3.
Anal fistulas require surgical treatment to cure the fistula. Fistulotomy is the treatment of choice because of its high success rate, but it also carries a risk of postoperative incontinence. Different methods have been proposed to overcome the need for dividing part or all of the sphincter, so-called "sphincter saving techniques" (SST), such as flap advancement, intrafistular injection of glue, or the insertion of a bio-prosthesis (collagen plug). However, the success rate of SSTs is lower than that of fistulotomy. Ligation of the Intersphincteric Fistula Tract (LIFT) is one of the most recent SSTs. It aims to ligate and transect the fistula by an approach through the intersphincteric space. The methodological quality of most published studies has been only average, but several studies have reported attractive success rates of 70 to 95% without postoperative incontinence. Other techniques such as endo-anal clip or injection of autologous stem cells are still anecdotal.
肛瘘需要手术治疗才能治愈。瘘管切开术是首选治疗方法，因其成功率高，但也有术后失禁的风险。人们提出了不同的方法来避免切开部分或全部括约肌，即所谓的“括约肌保留技术”（SST），如皮瓣推进、瘘管内注射胶水或插入生物假体（胶原塞）。然而，括约肌保留技术的成功率低于瘘管切开术。括约肌间瘘管结扎术（LIFT）是最新的括约肌保留技术之一。它旨在通过括约肌间间隙的方法结扎并横断瘘管。大多数已发表研究的方法学质量仅为中等，但一些研究报告了70%至95%的诱人成功率且无术后失禁。其他技术，如肛门内夹闭或自体干细胞注射，仍属个别案例。
