Department of Surgery, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
Dis Colon Rectum. 2018 Apr;61(4):499-503. doi: 10.1097/DCR.0000000000001045.
The ideal management for fistula-in-ano would resolve the disease while preserving anal continence.
The purpose of this study was to determine the efficacy of draining seton alone in achieving resolution or significant amelioration of symptoms for patients with fistula-in-ano.
This was a retrospective case series involving chart review and telephone interviews. A single colorectal surgeon performed surgeries between June 1, 2005, and June 30, 2014.
The study was conducted by a single surgeon in a large urban city.
Patient ≥18 years of age presenting with fistula-in-ano of cryptoglandular origin were included.
Resolution of symptoms or significant symptom improvement requiring no additional surgical management and rate of recurrence were measured.
A total of 76 patients (53 men) met the inclusion criteria. Mean age was 45 years (range, 19-73 y). The average time to seton removal was 36.6 weeks (range, 6.0-188.0 wk). Mean follow-up was 63 months (range, 7-121 mo). Fifty-seven patients (75%) were reached for telephone interview. Fifty-six patients (73.7%) had complete symptom resolution, and 14 (18.4%) had significant amelioration of symptoms with no additional surgical management required. Six (7.9%) had persistent severe symptoms. Five (7.1%) had a recurrence after seton removal. Rates of symptom resolution and recurrence were similar between patients whose setons were removed before or after 26 weeks (median time of seton removal) from the time of placement. Twenty-one patients (27.6%) required 1 or more additional operative procedures before planned seton removal to unroof a collection and/or replace the seton, and this represented the most significant risk factor for failure of resolution or improvement or recurrence (relative risk = 7.0).
This study was retrospective and represents a single surgeon experience.
Placement of draining seton alone is a viable treatment option for definitive symptomatic management of fistula-in-ano. Because draining setons are sphincter and function preserving, their use should be considered as primary management for fistula-in-ano. See Video Abstract at http://links.lww.com/DCR/A552.
肛门瘘的理想治疗方法是在保留肛门控便功能的同时治愈疾病。
本研究旨在确定单纯引流挂线术治疗肛门瘘的疗效，以达到缓解或显著改善肛门瘘症状的目的。
这是一项回顾性病例系列研究，包括病历回顾和电话访谈。一位肛肠外科医生于 2005 年 6 月 1 日至 2014 年 6 月 30 日期间进行了手术。
这项研究由一位外科医生在一个大城市进行。
≥18 岁，患有原发性肛隐窝来源的肛门瘘的患者被纳入研究。
测量症状缓解或显著改善（无需进一步手术治疗）的比例以及复发率。
共有 76 例（53 例男性）符合纳入标准。平均年龄为 45 岁（范围 19-73 岁）。挂线去除的平均时间为 36.6 周（范围 6.0-188.0 周）。平均随访时间为 63 个月（范围 7-121 个月）。对 57 例患者（75%）进行了电话访谈。56 例患者（73.7%）症状完全缓解，14 例患者（18.4%）症状显著改善，无需进一步手术治疗。6 例患者（7.9%）仍有严重症状。5 例患者（7.1%）在挂线去除后复发。在放置挂线后 26 周（中位数时间）之前或之后去除挂线的患者中，症状缓解和复发的比例相似。21 例患者（27.6%）在计划去除挂线前需要 1 次或多次额外的手术来打开脓肿和/或更换挂线，这是治疗失败、缓解或改善或复发的最显著危险因素（相对风险=7.0）。
本研究为回顾性研究，仅代表一位外科医生的经验。
单纯引流挂线术是治疗肛门瘘的一种可行的治疗选择，可明确缓解症状。由于引流挂线术可保留括约肌和功能，应将其作为肛门瘘的主要治疗方法。详见视频摘要，网址：http://links.lww.com/DCR/A552。
