Degtiarenko S P
Klin Khir. 2014 Oct(10):16-9.
The methods of sphincterpreserving operative interventions, and a principally new algorithm of treatment was elaborated for enhancing of the treatment efficacy in patients, suffering complex rectal fistulas. There were examined 291 patients, ageing 20 - 62 yrs old, all of whom operated on in Odessa Rural Clinical Hospital in 2003 - 2014 yrs for complex transsphincteric and extrasphincteric rectal fistulas. In 120 patients (I clinical group) a ligature method in accordance to standard procedure was applied; in 108 (II group)--a plastic method with transposition of mucosa-submucosal flap in accordance to original procedure; in 63 (III group)--a method of intrasphincteric ligature of complex rectal fistulas. Application of plastic method of intrasphincteric ligature of complex rectal fistulas have permitted to omit the anal incontinence, to reduce the unemployment period in 2 - 2.5 times. But a recurrence rate after sphincterpreserving operations is certainly bigger: while a ligature method application--by 5%, of a plastic one--11.1%, of intrasphincteric ligature--9.2%. Application of elaborated algorithm for the patients treatment for complex rectal fistulas have promoted preservation of high quality of life in 96.3% patients, as well as reduction of rate of their disabling.
为提高复杂性直肠瘘患者的治疗效果，制定了保留括约肌的手术干预方法及一种全新的治疗方案。对291例年龄在20至62岁之间的患者进行了检查，这些患者于2003年至2014年期间在敖德萨农村临床医院接受了复杂性经括约肌和括约肌外直肠瘘手术。120例患者（第一临床组）采用了符合标准程序的结扎法；108例患者（第二组）采用了根据原创程序进行黏膜-黏膜下瓣移位的整形法；63例患者（第三组）采用了复杂性直肠瘘括约肌内结扎法。采用复杂性直肠瘘括约肌内结扎整形法可避免肛门失禁，将失业期缩短2至2.5倍。但保留括约肌手术后的复发率肯定更高：采用结扎法为5%，采用整形法为11.1%，采用括约肌内结扎法为9.2%。采用为复杂性直肠瘘患者精心制定的治疗方案，96.3%的患者生活质量得以保持较高水平，致残率也有所降低。
