采用激光封闭肛门周围瘘：103 例患者的长期结果。

Closing Perianal Fistulas Using a Laser: Long-Term Results in 103 Patients.

机构信息

Department of General Surgery, Dokuz Eylul University School of Medicine, Izmir, Turkey.

Department of General Surgery, Hekimhan State Hospital, Malatya, Turkey.

出版信息

Dis Colon Rectum. 2018 May;61(5):599-603. doi: 10.1097/DCR.0000000000001038.

DOI:10.1097/DCR.0000000000001038

PMID:29528908

Abstract

BACKGROUND

Primary closure of the fistula tract using energy emitted by a radial fiber connected to a diode laser is a novel procedure for treating perianal fistulas.

OBJECTIVE

The aim of this study was to determine the long-term effectiveness of this new technique.

DESIGN

The surgical objective was to seal the fistula tract using laser energy.

SETTINGS

The study was conducted at a single day-case surgery center.

PATIENTS

Between April 2012 and June 2016, 103 consecutive patients with primary or recurrent perianal fistula underwent a laser closure procedure using a 12-watt laser emitting at a wavelength of 1470 nm.

MAIN OUTCOME MEASURES

Patients were classified according to the Park classification, and healing was evaluated based on the perianal fistula disease severity score.

RESULTS

Among the 103 patients treated using the laser closure procedure, 82 (80%) were men and 21 (20%) were women. The median age of the patients was 43 years (range, 18-78 y). Fifty-three patients (52%) had previous perianal fistula repair surgery. Based on the Park classification, 56 patients (54%) had intersphincteric fistula, 29 (28%) had transsphincteric fistula, 11 (11%) had suprasphincteric or extrasphincteric fistula, and 7 (7%) had superficial perianal fistula. Based on the perianal disease severity score, 41 patients (40%) obtained overall complete healing, 38 (37%) had persistent symptomatic drainage, 20 (19%) had slight drainage with minimal symptoms, and 4 (4%) had painful symptomatic drainage.

LIMITATIONS

This was a retrospective analysis of noncomparative data with a lack of formal prospective continence assessment.

CONCLUSIONS

Closure of perianal fistulas using a laser should be considered as a treatment option but with modest expectations. Although our complete healing rate was not as high as in earlier studies, this technique is a reasonable option with nearly no risk of sphincter damage when treating perianal fistulas. See Video Abstract at http://links.lww.com/DCR/A545.

摘要

背景

使用连接二极管激光的径向光纤发射的能量对瘘管进行一期缝合是治疗肛周瘘的一种新方法。

目的

本研究旨在确定该新技术的长期疗效。

设计

手术的目的是使用激光能量封闭瘘管。

地点

本研究在一家日间手术中心进行。

患者

2012 年 4 月至 2016 年 6 月，103 例原发性或复发性肛周瘘患者接受了使用 12 瓦、波长 1470nm 的激光进行的激光闭合术。

主要观察指标

患者根据 Park 分类进行分类，并根据肛周瘘疾病严重程度评分评估愈合情况。

结果

在接受激光闭合术的 103 例患者中，82 例（80%）为男性，21 例（20%）为女性。患者的中位年龄为 43 岁（范围 18-78 岁）。53 例（52%）患者有既往肛周瘘修复手术史。根据 Park 分类，56 例（54%）为括约肌间瘘，29 例（28%）为经括约肌瘘，11 例（11%）为高位或高位外括约肌瘘，7 例（7%）为浅表性肛周瘘。根据肛周疾病严重程度评分，41 例（40%）患者获得完全总体愈合，38 例（37%）患者有持续症状性引流，20 例（19%）患者有轻微症状性引流，4 例（4%）患者有疼痛性症状性引流。