Wu Wenjing, Yang Guangen, Du Zhongju, Zhang Xiufeng, Song Yihuan, Qiu Jianming, Liao Xiujun, Shen Zhong
Department of Anorectal Surgery, Hangzhou Third People's Hospital, Hangzhou 310009, China.
Zhonghua Wei Chang Wai Ke Za Zhi. 2014 Dec;17(12):1194-7.
To assess the efficacy and safety of modified ligation of the intersphincteric fistula tract for simple transsphincteric perianal fistula.
Seventy patients with simple transsphincteric perianal fistula between October 2012 and January 2014 in our department were prospectively enrolled. According to the random number table, patients were divided into two groups: modified-LIFT group (37 cases, from the external opening close to the fistula, dissect the external sphincter fistula to the intersphincteric groove by tunneling technique, resect the lateral free fistula) and LIFT group (33 cases). Clinical parametres before and after operation were compared, and results of pelvic electromyogram (EMG) and anorectal manometry three months after operation were analyzed to evaluated anal function.
The operative time, pain score, hospital stay, and healing time were not significantly different between the two groups (all P>0.05). During the median follow-up of 12 months (3-20 months), the healing rate in modified-LIFT group was 83.8% (31/37), which was significantly higher than 60% (20/33) in LIFT group (P=0.029). After operation, 4 patients had persistent unhealed wound, 2 recurred in modified-LIFT group, while 8 patients had persistent unhealed wound, and 5 recurred in LIFT group. No patients developed anal incontinence. By the pelvic EMG and anorectal manometry 3 months after operation, the duration of motor unit potential, occurrence of simple phase, mean resting pressure and maximun squeeze pressure were not significantly different.
Modified-LIFT procedure for the management of simple transsphincteric perianal fistulas is a simple and effective operation with higher healing rate and similar anal function as LIFT.
评估改良括约肌间瘘管结扎术治疗单纯经括约肌型肛瘘的疗效及安全性。
前瞻性纳入2012年10月至2014年1月在我科就诊的70例单纯经括约肌型肛瘘患者。根据随机数字表，将患者分为两组：改良LIFT组（37例，从靠近瘘管的外口开始，采用隧道技术将外括约肌瘘管分离至括约肌间沟，切除外侧游离瘘管）和LIFT组（33例）。比较手术前后的临床参数，并分析术后3个月的盆腔肌电图（EMG）和肛肠测压结果以评估肛门功能。
两组患者的手术时间、疼痛评分、住院时间和愈合时间差异均无统计学意义（均P>0.05）。在中位随访12个月（3 - 20个月）期间，改良LIFT组的愈合率为83.8%（31/37），显著高于LIFT组的60%（20/33）（P = 0.029）。术后，改良LIFT组有4例患者伤口持续未愈合，2例复发，而LIFT组有8例患者伤口持续未愈合，5例复发。无患者发生肛门失禁。术后3个月通过盆腔EMG和肛肠测压，运动单位电位持续时间、单相波出现情况、平均静息压力和最大收缩压力差异均无统计学意义。
改良LIFT手术治疗单纯经括约肌型肛瘘是一种简单有效的手术方法，愈合率更高，且肛门功能与LIFT手术相似。
