Boenicke Lars, Karsten Eduard, Zirngibl Hubert, Ambe Peter
Department of General and Visceral Surgery, Helios University Hospital Wuppertal, University Witten-Herdecke, Heusnerstraße 40, 42283, Wuppertal, Germany.
Centre of Coloproctology, Wuppertal, Germany.
World J Surg. 2017 Sep;41(9):2395-2400. doi: 10.1007/s00268-017-4006-7.
Multiple new procedures for treatment of complex anal fistula have been described in the past decades, but an ideal single technique has yet not been identified. Factors that predict the outcome are required to identify the best procedure for each individual patient. The aim of this study was to find those predictors for advancement flap at midterm follow-up.
From 2012 to 2015 in a tertiary university clinic, all patients who underwent advancement flap for treatment of complex cryptoglandular fistula were prospectively enrolled. Pre- and postoperatively standardized anamnestic and clinical examinations were performed. Predictive factors for therapy failure were identified using univariate and multivariate analysis.
Out of 65 patients, 61 (93%) completed all examinations and were included in the study. Therapy failure after a mean follow-up period of 25 months occurred in total n = 11 patients (18%). There was no significant disturbance of continence among the entire study cohort as shown by the incontinence score (preop 0.34 ± 0.91 pts., postop 0.37 ± 0.97 pts.; p = 0.59). Univariate analysis for risk factors for therapy failure revealed age (p = 0.004), history of surgical abscess drainage (p = 0.04), BMI (p = 0.002), suprasphincteric fistula (p = 0.019) and horseshoe abscess (p = 0.036) as independent parameters for therapy failure. During multivariate analysis, only history of surgical abscess drainage (OR = 8.09, p = 0.048, 95% CI 0.98-64.96), suprasphincteric fistula (OR = 6.83, p = 0.032, 95% CI 1.17-6.83) and BMI (OR = 1.23, p = 0.017, 95% CI 1.03-1.46) were independent parameters for therapy failure.
Advancement flap for treatment of complex fistula is effective and has low risk of disturbed continence. BMI, suprasphincteric fistula and history of surgical abscess drainage are predictors for therapy failure.
在过去几十年中，已经描述了多种治疗复杂性肛瘘的新方法，但尚未确定一种理想的单一技术。需要能够预测治疗结果的因素，以便为每个患者确定最佳治疗方法。本研究的目的是在中期随访中找出推进皮瓣术的这些预测因素。
2012年至2015年期间，在一所三级大学诊所，前瞻性纳入了所有接受推进皮瓣术治疗复杂性隐窝腺性肛瘘的患者。术前和术后均进行了标准化的问诊和临床检查。使用单因素和多因素分析确定治疗失败的预测因素。
65例患者中，61例（93%）完成了所有检查并纳入研究。在平均25个月的随访期后，共有11例患者（18%）出现治疗失败。失禁评分显示，整个研究队列中的控便功能没有明显障碍（术前0.34±0.91分，术后0.37±0.97分；p=0.59）。治疗失败危险因素的单因素分析显示，年龄（p=0.004）、手术脓肿引流史（p=0.04）、体重指数（BMI）（p=0.002）、括约肌上肛瘘（p=0.019）和马蹄形脓肿（p=0.036）是治疗失败的独立参数。在多因素分析中，只有手术脓肿引流史（OR=8.09，p=0.048，95%CI 0.98-64.96）、括约肌上肛瘘（OR=6.83，p=0.032，95%CI 1.17-6.83）和BMI（OR=1.23，p=0.017，95%CI 1.03-1.46）是治疗失败的独立参数。
推进皮瓣术治疗复杂性肛瘘有效，且控便功能障碍风险低。BMI、括约肌上肛瘘和手术脓肿引流史是治疗失败的预测因素。
