治疗高位肛瘘的PERFACT手术：一种新型的单阶段保留括约肌手术。
PERFACT procedure to treat supralevator fistula-in-ano: A novel single stage sphincter sparing procedure.
作者信息
Garg Pankaj
机构信息
Pankaj Garg, Colorectal Surgery Division, Indus Super Specialty Hospital, Mohali, Punjab 160055, India.
出版信息
World J Gastrointest Surg. 2016 Apr 27;8(4):326-34. doi: 10.4240/wjgs.v8.i4.326.
AIM
To prospectively perform the PERFACT procedure in supralevator anal fistula/abscess.
METHODS
Magnetic resonance imaging was done preoperatively in all the patients. Proximal cauterization around the internal opening, emptying regularly of fistula tracts and curettage of tracts (PERFACT) was done in all patients with supralevator fistula or abscess. All types of anal fistula and/or abscess with supralevator extension, whether intersphincteric or transsphincteric, were included in the study. The internal opening along with the adjacent mucosa was electrocauterized. The resulting wound was left open to heal by secondary intention so as to heal (close) the internal opening by granulation tissue. The supralevator tract/abscess was drained and thoroughly curetted. It was regularly cleaned and kept empty in the postoperative period. The primary outcome parameter was complete fistula healing. The secondary outcome parameters were return to work and change in incontinence scores (Vaizey objective scoring system) assessed preoperatively and at 3 mo after surgery.
RESULTS
Seventeen patients were prospectively enrolled and followed for a median of 13 mo (range 5-21 mo). Mean age was 41.1 ± 13.4 years, M:F - 15:2. Fourteen (82.4%) had a recurrent fistula, 8 (47.1%) had an associated abscess, 14 (82.4%) had multiple tracts and 5 (29.4%) had horseshoe fistulae. Infralevator part of fistula was intersphincteric in 4 and transsphincteric in 13 patients. Two patients were excluded. Eleven out of fifteen (73.3%) were cured and 26.7% (4/15) had a recurrence. Two patients with recurrence were reoperated on with the same procedure and one was cured. Thus, the overall healing rate was 80% (12/15). All the patients could resume normal work within 48 h of surgery. There was no deterioration in incontinence scores (Vaizey objective scoring system). This is the largest series of supralevator fistula-in-ano (SLF) published to date.
CONCLUSION
PERFACT procedure is an effective single step sphincter saving procedure to treat SLF with minimal risk of incontinence.
目的
前瞻性地对肛提肌上肛瘘/脓肿实施PERFACT手术。
方法
所有患者均在术前进行磁共振成像检查。对所有肛提肌上肛瘘或脓肿患者进行内口周围近端烧灼、瘘管定期排空及瘘管刮除术（PERFACT）。本研究纳入所有伴有肛提肌上延伸的各类肛瘘和/或脓肿，无论其为括约肌间型还是经括约肌型。内口连同相邻黏膜进行电灼。所形成的伤口敞开，通过二期愈合，以便通过肉芽组织使内口愈合（闭合）。对肛提肌上瘘管/脓肿进行引流并彻底刮除。术后定期进行清洁并保持引流通畅。主要结局参数为肛瘘完全愈合。次要结局参数为恢复工作情况以及术前和术后3个月评估的失禁评分变化（Vaizey客观评分系统）。
结果
前瞻性纳入17例患者并进行中位时间为13个月（范围5 - 21个月）的随访。平均年龄为41.1±13.4岁，男:女 = 15:2。14例（82.4%）为复发性肛瘘，8例（47.1%）伴有脓肿，14例（82.4%）有多个瘘管，5例（29.4%）为马蹄形肛瘘。13例患者的肛瘘括约肌下部分为经括约肌型，4例为括约肌间型。2例患者被排除。15例中有11例（73.3%）治愈，4例（26.7%）复发。2例复发患者再次接受相同手术，其中1例治愈。因此，总体愈合率为80%（12/15）。所有患者在术后48小时内均可恢复正常工作。失禁评分（Vaizey客观评分系统）无恶化。这是迄今为止发表的最大系列的肛提肌上肛瘘（SLF）研究。
结论
PERFACT手术是一种有效的单步保括约肌手术，用于治疗SLF，失禁风险极小。
Zotero 插件