经肛门括约肌间切开术治疗肛瘘。
Transanal Opening of Intersphincteric Space for Fistula-in-Ano.
机构信息
Colorectal Surgery Division, 248924The First Affiliated Hospital of Guangxi University of Chinese Medicine, Nanning, Guangxi, China.
Colorectal Surgery Division, 105809Affiliated Hospital of Jinggangshan University, Ji'an, Jiangxi, China.
出版信息
Am Surg. 2022 Jun;88(6):1131-1136. doi: 10.1177/0003134821989048. Epub 2021 Jan 30.
BACKGROUND
The role of the intersphincteric space in the pathogenesis of fistula-in-ano is being increasingly recognized. Submucosal and intersphincteric rectal abscesses have been surgically managed by laying open and draining the intersphincteric space as well as by the modified ligation of intersphincteric fistula tract (LIFT) procedure. In 2017, the transanal opening of intersphincteric space (TROPIS) technique was reported for the treatment of high, complex anal fistulae.
AIM
We aim to investigate the advantages of performing the TROPIS procedure in patients with fistula-in-ano.
METHODS
This was a prospective cohort study investigating the outcomes in patients who had undergone a procedure using the TROPIS technique for the treatment of fistula-in-ano. Preoperative magnetic resonance imaging scans and electronic colonoscopies were performed on all patients. A clinical database evaluating the following variables was constructed: age, gender, body mass index (BMI), previous fistula surgery, type of fistula, postoperative complications, duration of follow-up, success rate, and incontinence scores pre- and postoperatively.
RESULTS
The TROPIS procedure was performed on 41 patients with fistula-in-ano with a follow-up time of 6-23 months. The characteristics of the patients were as follows: 36 males, 6 females, mean age 38.6±13.2 years, and mean BMI 23.5±3.9 kg·m. All patients (41) had transsphincteric fistulae, and 90.2% (37) had high fistula. Of the 41 patients, 22% (9) had recurrent fistulae, 29.27% (12) had horseshoe fistulae, 7.3% (3) had supralevator fistulae, and 14.6% (6) had an associated abscess. The fistula healed completely in 85.3% (35) of patients and failed to heal in 14.7% (6) of patients, and the healing of high fistula was 86.5% (32). Of those patients who had not healed completely, 2 were found to have contracted iatrogenic infections due to foreign residues and underwent surgery with the passing of a loose seton. The additional 4 patients who had not healed underwent a fistulotomy and healed completely thereafter. There were no significant changes in incontinence scores. The incontinence scores were .15 ± .36 preoperatively and .22 ± .47 3 months postoperatively (t = -1.438, = .16).
CONCLUSIONS
The TROPIS technique is a novel sphincter-preserving procedure, which can be effectively used in treating fistula-in-ano.
背景
肛痿的发病机制中，肛提肌间隙的作用越来越受到重视。黏膜下和肛提肌间隙直肠脓肿已通过切开引流肛提肌间隙以及改良的肛提肌间隙瘘管结扎术（LIFT）进行手术治疗。2017 年，经肛提肌间隙切开术（TROPIS）技术被报道用于治疗高位、复杂的肛痿。
目的
我们旨在探讨 TROPIS 手术治疗肛痿患者的优势。
方法
这是一项前瞻性队列研究，调查了接受 TROPIS 手术治疗肛痿的患者的结果。所有患者均行术前磁共振成像扫描和电子结肠镜检查。建立了一个评估以下变量的临床数据库：年龄、性别、体重指数（BMI）、既往肛痿手术、痿类型、术后并发症、随访时间、成功率和术前及术后的失禁评分。
结果
TROPIS 手术治疗肛痿 41 例，随访时间 6-23 个月。患者的特征如下：男性 36 例，女性 6 例，平均年龄 38.6±13.2 岁，平均 BMI 23.5±3.9kg·m。所有患者（41 例）均为经括约肌痿，90.2%（37 例）为高位痿。41 例患者中，22%（9 例）为复发痿，29.27%（12 例）为马蹄形痿，7.3%（3 例）为高位痿，14.6%（6 例）为合并脓肿。85.3%（35 例）的患者痿完全愈合，14.7%（6 例）的患者痿未愈合，高位痿愈合 86.5%（32 例）。未完全愈合的患者中有 2 例因异物残留而发生医源性感染，行挂线术治疗。另外 4 例未愈合的患者行痿管切开术，随后完全愈合。失禁评分无明显变化。术前失禁评分为.15±.36，术后 3 个月为.22±.47（t=-1.438， =.16）。
结论
TROPIS 技术是一种新型的保肛术式，可有效用于治疗肛痿。
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