1Department of Colon and Rectal Surgery, Lahey Hospital and Medical Center, Burlington, Massachusetts 2Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts 3Department of Surgery, University of Vermont College of Medicine, Burlington, Vermont 4Department of Surgery, Hartford Healthcare Medical Group, Farmington, Connecticut.
Dis Colon Rectum. 2014 Nov;57(11):1304-8. doi: 10.1097/DCR.0000000000000216.
There are various surgical techniques used treat anal fistulas. The adoption and success rates of newer techniques have not been clearly established.
The purpose of this study was to determine the healing rate after operations for anal fistulas in New England colorectal surgery practices.
We conducted a retrospective review of a prospectively collected database.
The study was conducted at colorectal surgery practices in New England.
A prospective, multicenter registry was created by the New England Society of Colon and Rectal Surgeons. Surgeons were invited to collect data prospectively regarding patients operated on for anal fistulas between January 1, 2011, and August 1, 2013. Fistula classification, surgical intervention, continence scores, and healing were determined by the treating surgeon.
Operation for anal fistula was performed.
We measured the proportion of patients with healed fistulas at 3 months.
Sixteen surgeons submitted data regarding 240 operations for fistula with curative intent. Mean patient age was 45 ± 14 years. A total of 158 patients (66%) were men, and 110 (46%) had undergone an anorectal operation. Twenty-nine (12%) had Crohn's disease. The healing rates of fistulotomy, advancement flap, and fistula plugs at 3 months were 94% (95% CI, 89-97), 60% (95% CI, 33-77), and 20% (95% CI, 5-50). The healing rate of the ligation of intersphincteric fistula tract procedure at 3 months was 79% (95% CI, 65-88). Hospital site was the only variable associated with healing (p < 0.05). Hospitals that performed more ligation of intersphincteric fistula tract procedures had higher healing rates at 3 months (p < 0.0001).
This study was limited by selection bias and reporting bias.
A wide variety of techniques are used to treat anal fistulas in our region. Fistulotomy continues to have excellent results. There has been enthusiastic early adoption of the ligation of intersphincteric fistula tract technique. Early healing rates after the ligation of intersphincteric fistula tract procedure appear to be excellent.
目前有多种手术技术可用于治疗肛瘘。但新手术技术的采用率和成功率尚未明确。
本研究旨在确定新英格兰地区结直肠外科手术中肛瘘手术后的愈合率。
我们对前瞻性收集的数据库进行了回顾性研究。
该研究在新英格兰的结直肠外科手术中进行。
新英格兰结直肠外科学会创建了一个前瞻性、多中心登记处。邀请外科医生前瞻性收集 2011 年 1 月 1 日至 2013 年 8 月 1 日期间接受肛瘘手术治疗的患者数据。瘘管分类、手术干预、控便评分和愈合情况由治疗外科医生确定。
行肛瘘手术。
测量 3 个月时愈合瘘管的患者比例。
16 名外科医生提供了 240 例有治愈意向的肛瘘手术数据。患者平均年龄为 45 ± 14 岁。158 例（66%）为男性，110 例（46%）曾行肛门直肠手术。29 例（12%）患有克罗恩病。3 个月时，切开术、前徙术和瘘管塞的愈合率分别为 94%（95%CI，89-97）、60%（95%CI，33-77）和 20%（95%CI，5-50）。括约肌间瘘管结扎术的 3 个月愈合率为 79%（95%CI，65-88）。医院地点是唯一与愈合相关的变量（p<0.05）。行括约肌间瘘管结扎术较多的医院，3 个月时的愈合率更高（p<0.0001）。
本研究存在选择偏倚和报告偏倚。
在我们地区，有多种技术可用于治疗肛瘘。切开术的结果仍然很好。括约肌间瘘管结扎术的早期应用非常活跃。括约肌间瘘管结扎术的早期愈合率似乎非常好。
