Araki Yoshiro, Kagawa Ryuzaburo, Yasui Hiroshi, Tomoi Masahiro
Department of Proctology, Rakuwakai Otowa Hospital.
Department of Pathology, Rakuwakai Otowa Hospital.
J Anus Rectum Colon. 2018 May 25;1(1):22-28. doi: 10.23922/jarc.2016-005. eCollection 2017.
To evaluate the rules for anal fistulas with scrotal extension, in particular, whether a high transsphincteric or suprasphincteric fistula, of which internal openings are usually located posteriorly, would extend into the scrotum.
We retrospectively analyzed 446 consecutive male patients who underwent definitive anal fistula surgery. We compared fistulas with scrotal extension according to the location of the internal opening and divided them into anterior and posterior groups.
Forty-six (82.1%) of the 56 anal fistulas with scrotal extension had anterior internal openings. After excluding recurrent fistulas, 42 (87.5%) of the 48 anal fistulas with scrotal extension had anterior internal openings. The relative risk of scrotal extension in the anterior group was 14.22 times higher than that in the posterior group (95% CI: 7.43-27.21; p<0.0001). After excluding recurrent fistulas, this relative risk rose to 18.67 (95% CI: 8.18-42.58), (p<0.0001).
Anal fistulas with scrotal extension are mostly low transsphincteric or intersphincteric with anterior internal openings. High transsphincteric or suprasphincteric fistulas rarely extend into the scrotum, except in recurrent cases.
评估伴有阴囊延伸的肛瘘的规律，特别是内部开口通常位于后方的高位经括约肌型或括约肌上型肛瘘是否会延伸至阴囊。
我们回顾性分析了446例连续接受确定性肛瘘手术的男性患者。我们根据内部开口的位置比较了伴有阴囊延伸的肛瘘，并将它们分为前组和后组。
56例伴有阴囊延伸的肛瘘中，46例（82.1%）内部开口在前。排除复发性肛瘘后，48例伴有阴囊延伸的肛瘘中有42例（87.5%）内部开口在前。前组阴囊延伸的相对风险比后组高14.22倍（95%可信区间：7.43 - 27.21；p<0.0001）。排除复发性肛瘘后，该相对风险升至18.67（95%可信区间：8.18 - 42.58），（p<0.000）。
伴有阴囊延伸的肛瘘大多为低位经括约肌型或括约肌间型，内部开口在前。高位经括约肌型或括约肌上型肛瘘很少延伸至阴囊，复发性病例除外。
