Jayarajah U, Samarasekera D N
Department of Surgery, Faculty of Medicine, University of Colombo, Sri Lanka.
Ceylon Med J. 2017 Jun 30;62(2):97-99. doi: 10.4038/cmj.v62i2.8474.
Successful treatment of fistula-in-ano is sometimes challenging due to difficulty in recognising the internal opening and the course of the fistula tract. Although Goodsall’s rule was accepted in the past, as a method to determine the course of the fistula, recent data have shown conflicting results.
To study the predictive accuracy of Goodsall’s rule.
A sample of 212 patients with simple fistulae were studied. Hydrogen peroxide was injected through the external opening and the appearance of air bubbles in the anal canal indicated the location of the internal opening. The morphological parameters including the site and number of internal and external opening/s and the course of the tract were recorded.
The median age of the participants was 39 (range, 18-78) years. The majority (n=167, 78.8%) were males. Of the study group, 63 (29.7%) had inter-sphincteric fistulae, 114 (53.8%) transphincteric fistulae and 35 (16.5%) superficial fistulae. The overall predictive accuracy of Goodsall’s rule in our patients was 78.3%. Predictive accuracy was significantly associated with type of fistulae with high predictive accuracy seen in superficial fistulae (97.1%) and inter-sphincteric fistulae (84.1%) compared to transphincteric fistulae (69.3%) (p=0.001). Predictive accuracy was significantly higher in those with an external opening in the midline (98.2%), (p<0.001).
Although Goodsall’s rule was not accurate in 22% of all fistulae, it can be used as a guide in locating the path of the tract and the internal opening in simple fistulae.
由于难以识别肛瘘的内口和瘘管走行，肛瘘的成功治疗有时具有挑战性。尽管古德索尔法则（Goodsall's rule）过去被用作确定瘘管走行的方法，但最近的数据显示结果相互矛盾。
研究古德索尔法则的预测准确性。
对212例单纯性肛瘘患者进行研究。通过外口注入过氧化氢，肛管内气泡的出现表明内口的位置。记录形态学参数，包括内、外口的位置和数量以及瘘管走行。
参与者的中位年龄为39岁（范围18 - 78岁）。大多数（n = 167，78.8%）为男性。在研究组中，63例（29.7%）为括约肌间肛瘘，114例（53.8%）为经括约肌肛瘘，35例（16.5%）为浅表性肛瘘。古德索尔法则在我们患者中的总体预测准确性为78.3%。预测准确性与肛瘘类型显著相关，浅表性肛瘘（97.1%）和括约肌间肛瘘（84.1%）的预测准确性高于经括约肌肛瘘（69.3%）（p = 0.001）。外口位于中线的患者预测准确性显著更高（98.2%），（p < 0.001）。
尽管古德索尔法则在所有肛瘘中22%的情况下不准确，但它可作为定位单纯性肛瘘瘘管路径和内口的指导。
