经肛门括约肌间切开术治疗 325 例高复杂性肛瘘：一项具有长期随访的新型保肛手术。
Transanal opening of the intersphincteric space: a novel sphincter-sparing procedure to treat 325 high complex anal fistulas with long-term follow-up.
机构信息
Indus International Hospital, Mohali, India.
Garg Fistula Research Institute, Panchkula, India.
出版信息
Colorectal Dis. 2021 May;23(5):1213-1224. doi: 10.1111/codi.15555. Epub 2021 Feb 19.
AIM
Sepsis in the intersphincteric plane behaves like an abscess in a closed space and is present in most complex fistulas. Ignoring this sepsis is a cause of recurrence. Complex fistulas can be successfully managed by transanal opening of the intersphincteric space (TROPIS) into the anal canal. The long-term efficacy of the TROPIS procedure was analysed in an exclusive cohort of high complex anal fistulas.
METHODS
All consecutive patients operated for a high complex fistula-in-ano were included prospectively. Preoperative MRI scans were obtained for all the patients. The intersphincteric space and internal opening was laid open into the anal canal while preserving the external sphincter. The external tracts were thoroughly curetted and cleaned. Fistula healing rate and objective incontinence scores (preoperatively and during long-term follow-up) were analysed.
RESULTS
A total of 325 patients (age 39.9 ± 10.9 years, 292 men) were operated with TROPIS and had a follow-up of 7-67 months (median 36 months). In the cohort, 67.4% (219) had recurrent fistulas, 82.8% (269) had multiple tracts, 36.3% (118) had horseshoe tracts, 37.5% (122) had associated abscesses and 24% (78) were supralevator fistulas. Nineteen patients were excluded. Fistulas healed completely in 78.4% (240/306) of patients and did not heal in 21.6% (66/306) of patients. 36/66 of these patients were operated again and the fistulas healed in 28 patients. Thus, the overall healing rate was 87.6% (268/306). The mean preoperative and postoperative incontinence scores were 0.085 ± 0.35 and 0.119 ± 0.48 respectively (P = 0.38). The healing rate of fistulas with associated acute abscesses was similar to the fistulas without abscesses (87% vs. 88%, P = 0.85).
CONCLUSION
Transanal opening of the intersphincteric space is a safe and highly effective sphincter-sparing procedure to manage high complex fistulas-in-ano.
目的
括约肌间间隙的感染类似于封闭空间中的脓肿，并且存在于大多数复杂的瘘管中。忽略这种感染是复发的原因。通过经肛门切开括约肌间间隙（TROPIS）进入肛管，可以成功地管理复杂的瘘管。对一组高复杂性肛瘘患者进行了 TROPIS 手术的长期疗效分析。
方法
前瞻性纳入所有接受高复杂性肛瘘手术的连续患者。所有患者均行术前 MRI 扫描。在保留外括约肌的同时，将括约肌间间隙和内口开放至肛管。彻底刮除和清理外部管道。分析瘘管愈合率和客观失禁评分（术前和长期随访期间）。
结果
共有 325 例患者（年龄 39.9±10.9 岁，292 例男性）接受 TROPIS 手术，随访时间为 7-67 个月（中位随访时间 36 个月）。在该队列中，67.4%（219 例）有复发性瘘管，82.8%（269 例）有多个瘘管，36.3%（118 例）有马蹄形瘘管，37.5%（122 例）有伴发脓肿，24%（78 例）为高位瘘管。19 例患者被排除在外。78.4%（240/306）的患者瘘管完全愈合，21.6%（66/306）的患者瘘管未愈合。其中 36/66 例患者再次手术，28 例患者瘘管愈合。因此，总愈合率为 87.6%（268/306）。术前和术后失禁评分分别为 0.085±0.35 和 0.119±0.48（P=0.38）。伴发急性脓肿的瘘管愈合率与无脓肿的瘘管相似（87%比 88%，P=0.85）。
结论
经肛门切开括约肌间间隙是一种安全有效的保留括约肌的手术方法，可用于治疗高复杂性肛瘘。
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