Musin A I, Kostarev I V
Pirogov Russian National Research Medical University of Healthcare Ministry of the Russian Federation, Chair of Hospital-Based Surgery No. 1 of the Faculty of Medicine, Moscow, Russia.
Ryzhikh State Research Center of Coloproctology of Healthcare Ministry of the Russian Federation, Moscow, Russia.
Khirurgiia (Mosk). 2018(8. Vyp. 2):65-72. doi: 10.17116/hirurgia201808265.
Sphincter-sparing procedures for rectal fistulas are becoming more popular among coloproctologists. However, the outcomes are not optimal that forces surgeons to seek new approaches in order to improve results. Seton drainage prior to radical stage is one of these methods. The effect of seton drainage on the outcomes is reviewed in the article. Elibrary, Pubmed and Google Scholar databases were analyzed. We have assessed 14 out of 151 trials for the period 1984 - 2017. There were no significant advantages of seton drainage compared with single-stage approach (χ = 3.84, p> 0.05, RR = 0.95, CI 95% 0.84 - 1.08). The same situation is observed for mucomuscular flap bringing down to close internal fistula. Fistula healing was more common after seton drainage deployment within 4 - 8 weeks. Bringing down of the flap to anal canal should be preferred after drainage due to less incidence of recurrences. Further trials are necessary to determine advisability of seton drainage and optimal surgical approach.
保留括约肌的直肠瘘手术在结直肠外科医生中越来越受欢迎。然而，其效果并不理想，这迫使外科医生寻求新的方法来改善结果。根治术前的挂线引流就是其中一种方法。本文回顾了挂线引流对治疗结果的影响。分析了电子图书馆、PubMed和谷歌学术数据库。我们评估了1984年至2017年期间151项试验中的14项。与一期手术相比，挂线引流没有显著优势（χ = 3.84，p>0.05，RR = 0.95，95%CI 0.84 - 1.08）。将肌黏膜瓣下拉闭合内瘘的情况也是如此。在4 - 8周内进行挂线引流后，瘘管愈合更为常见。由于复发率较低，引流后应首选将瓣下拉至肛管。需要进一步的试验来确定挂线引流的可取性和最佳手术方法。
