Patton Vicki, Chen Chung Ming, Lubowski David
Department of Colorectal Surgery, St George Hospital, Sydney, New South Wales, Australia.
University of New South Wales, Sydney, New South Wales, Australia.
ANZ J Surg. 2015 Oct;85(10):720-7. doi: 10.1111/ans.13156. Epub 2015 May 21.
No single procedure for high anal fistula delivers a high cure rate while also completely protecting sphincter function. This paper reports our long-term results with the cutting seton for high fistulae and draws comparisons with advancement flap and ligation of intersphincteric fistula track (LIFT) procedures.
A retrospective study of prospectively collected data in consecutive patients undergoing treatment with cutting seton for high cryptoglandular fistulae was carried out. A strict protocol dictated tightening intervals of at least 4 weeks and no muscle division. In 59 patients (male : female = 39:20) followed-up at mean 9.4 years (range 1.7-15.6 years) healing rates, continence (St Mark's score 0-24), patient-perceived overall change in bowel control (-5 to +5), faecal incontinence quality of life (FIQL) and overall patient satisfaction (visual analogue score 0-10) were assessed.
Primary and secondary healing rates were 93% and 98%. Mean continence score was 4.1, significantly worse in women than men (median 6, range 0-22 versus median 1, range 0-17; P = 0.006). Seventy-eight per cent of patients had normal continence or minor incontinence (score 0-6), 13.5% moderate incontinence (score 7-12) and 8.5% severe incontinence (score >12). Sixty-three per cent of patients had no change or improved patient-perceived overall bowel control. Mean FIQL scores were high and significantly correlated with continence. Median satisfaction score was 9.
Cutting seton for high anal fistula achieved healing in 98% with good continence in the majority, particularly in males, and a high level of patient satisfaction. Multicentre prospective studies are needed to adequately compare cutting seton, flap and LIFT procedures.
目前尚无一种针对高位肛瘘的单一手术方法能在完全保护括约肌功能的同时实现高治愈率。本文报告了我们采用切开挂线疗法治疗高位肛瘘的长期结果，并与推进皮瓣术和括约肌间瘘管结扎术（LIFT）进行了比较。
对连续接受切开挂线疗法治疗高位隐窝腺性肛瘘患者的前瞻性收集数据进行回顾性研究。严格的方案规定收紧间隔至少4周且不进行肌肉切开。对59例患者（男∶女 = 39∶20）进行了平均9.4年（范围1.7 - 15.6年）的随访，评估了愈合率、控便能力（圣马克评分0 - 24分）、患者自我感知的排便控制总体变化（-5至+5）、大便失禁生活质量（FIQL）和患者总体满意度（视觉模拟评分0 - 10）。
一期愈合率和二期愈合率分别为93%和98%。平均控便评分为4.1分，女性明显比男性差（中位数6分，范围0 - 22分；男性中位数1分，范围0 - 17分；P = 0.006）。78%的患者控便正常或轻度失禁（评分0 - 6分），13.5%为中度失禁（评分7 - 1 twelve），8.5%为重度失禁（评分>12分）。63%的患者自我感知的排便控制无变化或有所改善。平均FIQL评分较高，且与控便能力显著相关。满意度中位数为9分。
高位肛瘘切开挂线疗法的愈合率达98%，大多数患者，尤其是男性，控便良好，患者满意度高。需要进行多中心前瞻性研究以充分比较切开挂线疗法、皮瓣术和LIFT手术。
