Department of General Surgery, Beijing Chaoyang Hospital, Capital Medical University, No. 8 Gongtinan Road, Chaoyang District, Beijing, 100020, People's Republic of China.
Langenbecks Arch Surg. 2021 May;406(3):855-861. doi: 10.1007/s00423-020-02024-5. Epub 2020 Nov 10.
The aim of this study was to evaluate the anal function in patients with trans-sphincteric anal fistulas who underwent an anal fistula plug procedure, and analyze risk factors that might affect post-operative anal function.
This was an observational, retrospective study of patients diagnosed with trans-sphincteric anal fistulas and initially underwent anal fistula plug procedures between August 2008 and September 2012 at our institute. The analysis includes clinical characteristics, anal fistula healing, and the Wexner score for pre- and post-operative anal function (0 = no incontinence to 20 = complete incontinence).
A total of 123 patients who had an adequate follow-up in the end were included. The median duration of follow-up was 8 years (range 72-121 months). The overall healing rate was 56% (69/123), and 33 (26.8%) patients had decreased anal function after surgery. The post-operative Wexner score on anal function was significantly higher than that before the operation (p < 0.001), as well as scores of gas, liquid stool, solid stool incontinence, and alteration in lifestyle (p < 0.05). Based on multiple logistic regression analysis, a high body mass index (p < 0.001) and long distance between the external opening and anal verge (p = 0.003) were significantly associated with a decline in post-operative anal function.
As a sphincter-preserving technique for the treatment of anal fistulas, the anal fistula plug procedure might impair the anal function. Especially for patients with obesity or long distance between the external opening of anal fistula and anal verge, the reduced anal function is more likely to occur after treatment with anal fistula plug therapy.
本研究旨在评估接受肛门瘘管栓治疗的经括约肌肛门瘘患者的肛门功能，并分析可能影响术后肛门功能的相关因素。
本研究为回顾性观察性研究，纳入 2008 年 8 月至 2012 年 9 月期间在我院接受肛门瘘管栓治疗的经括约肌肛门瘘患者。分析内容包括临床特征、肛门瘘管愈合情况以及术前和术后的 Wexner 肛门功能评分（0=无失禁，20=完全失禁）。
最终纳入 123 例获得充分随访的患者，中位随访时间为 8 年（72-121 个月）。总体愈合率为 56%（69/123），术后 33 例（26.8%）患者肛门功能下降。术后 Wexner 肛门功能评分显著高于术前（p<0.001），气体、液体粪便、固体粪便失禁以及生活方式改变的评分也显著高于术前（p<0.05）。多因素 logistic 回归分析显示，较高的体质指数（p<0.001）和瘘管外口与肛缘之间的距离较长（p=0.003）与术后肛门功能下降显著相关。
作为一种治疗肛门瘘的保留括约肌技术，肛门瘘管栓治疗可能会损害肛门功能。对于肥胖或瘘管外口与肛缘之间距离较长的患者，肛门瘘管栓治疗后更有可能出现肛门功能下降。
