Pellino Gianluca, Sciaudone Guido, Canonico Silvestro, Selvaggi Francesco
Ann Ital Chir. 2015 Jan-Feb;86(1):61-5.
To describe a method to manage complex perianal fistulas with extensive perineal involvement, allowing avoidance of exposure of wide wounds and repeated procedures.
All patients presenting with perianal fistulas extensively spreading to the perineum requiring surgery between January 2010 and December 2012 were enrolled in the present study. Diabetic patients and those with active abdominal Crohn's disease (CD) were ruled out from evaluation. After clinical and radiological assessment, patients underwent exploration under anaesthesia, and the conventional procedures were completed with at least one wide perineal fistulotomy, managed with "perineal packing" with gauzes. Patients were followed-up for complications and healing of fistulas.
Eight patients (3 males, mean age 38 ± 5.1 years) were enrolled in the present study. Four patients had CD, two had Hidradenitis suppurativa, and two had idiopathic fistula-in-ano. All but two patients were not required to stay overnight. Gauzes were removed in outpatient settings. One patient had bleeding requiring coagulation with electroscalpel. One patient needed to receive analgesics and four wore pads in the maturation period. No sepsis was observed. Mean time to healing was 21.5 ± 3.2 days; mean time off-work was 2 ± 1.3 days. Patients reported no significant impairment of leisure activities. No recurrences were observed at a mean follow-up of 16.4 ± 2.1 months. Major complications were not observed.
All patients achieved complete healing of the perineal tracks, without significant impairment of social function and need for further surgical treatments. Patients were safely discharged and promptly returned to work or leisure activities.
Our data suggest that the procedure is safe and effective in selected patients with extensive perineal involvement.
描述一种处理伴有广泛会阴受累的复杂肛周瘘的方法，避免大面积伤口暴露和重复手术。
纳入2010年1月至2012年12月期间因肛周瘘广泛蔓延至会阴而需手术的所有患者。排除糖尿病患者和患有活动性腹部克罗恩病（CD）的患者。经过临床和影像学评估后，患者在麻醉下进行探查，并完成常规手术，至少进行一次广泛的会阴瘘管切开术，采用纱布“会阴填塞”处理。对患者进行随访，观察并发症及瘘管愈合情况。
本研究纳入8例患者（3例男性，平均年龄38±5.1岁）。4例患有CD，2例患有化脓性汗腺炎，2例患有特发性肛瘘。除2例患者外，其余患者均无需过夜住院。在门诊取出纱布。1例患者出血，需用电刀凝血。1例患者在愈合期需要服用镇痛药，4例患者使用了护垫。未观察到脓毒症。平均愈合时间为21.5±3.2天；平均误工时间为2±1.3天。患者报告休闲活动未受到明显影响。平均随访16.4±2.1个月未观察到复发。未观察到严重并发症。
所有患者的会阴瘘道均完全愈合，社会功能未受到明显影响，也无需进一步手术治疗。患者安全出院，并迅速恢复工作或休闲活动。
我们的数据表明，该手术方法对于伴有广泛会阴受累的特定患者是安全有效的。
