Xu Yansong, Tang Weizhong
Emergency Department, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China.
Colorectal and Anal Department, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China.
ANZ J Surg. 2016 Dec;86(12):978-982. doi: 10.1111/ans.13751. Epub 2016 Sep 29.
The aim of this analysis was to compare the advantages of the anal fistula plug (AFP) with the mucosa advancement flap (MAF) for complex anal fistulas.
Comparative studies of the efficacy of AFP and MAF were included. Two independent reviewers selected articles for inclusion. After information collection, a meta-analysis was performed using data on overall healing rates, complications, incontinences and recurrences. The quality of postoperative life and cost were also included with the clinical results.
Ten studies included 778 patients who were divided into AFP and MAF groups in this meta-analysis. During the follow-up period, no significant difference in healing rates, complications and recurrences were found (P = 0.55, P = 0.78 and P = 0.23, respectively). The incontinence rate of AFP was lower than that of MAF (P = 0.04). The postoperative quality of life of AFP patients was superior to that of MAF patients. The AFP patients had less persistent pain of a shorter duration and shortened healing time and hospital stay. The treatment cost of AFP patient was lower than that of MAF.
Compared to the MAF procedure, the AFP procedure has some advantages for complex anal fistulas, but more and large randomized clinical trials comparing the two procedures for fistula management need to be conducted.
本分析旨在比较肛瘘塞（AFP）与黏膜推进皮瓣（MAF）治疗复杂性肛瘘的优势。
纳入AFP和MAF疗效的比较研究。两名独立评审员筛选纳入文章。收集信息后，使用总体愈合率、并发症、失禁和复发数据进行荟萃分析。术后生活质量和成本也纳入临床结果。
10项研究共778例患者，在本次荟萃分析中分为AFP组和MAF组。随访期间，愈合率、并发症和复发率无显著差异（分别为P = 0.55、P = 0.78和P = 0.23）。AFP组的失禁率低于MAF组（P = 0.04）。AFP患者术后生活质量优于MAF患者。AFP患者持续疼痛时间更短，愈合时间和住院时间缩短。AFP患者的治疗成本低于MAF患者。
与MAF手术相比，AFP手术治疗复杂性肛瘘具有一些优势，但需要开展更多大规模的随机临床试验来比较这两种肛瘘治疗方法。
