Ji Lijiang, Zhang Yang, Xu Liang, Wei Jun, Weng Liping, Jiang Jie
Department of Anorectal Surgery, Changshu Hospital Affiliated to Nanjing University of Chinese Medicine, Changshu, China.
Colorectal Disease Center, Nanjing Hospital of Chinese Medicine Affiliated to Nanjing University of Chinese Medicine, Nanjing, China.
Front Surg. 2021 Feb 11;7:586891. doi: 10.3389/fsurg.2020.586891. eCollection 2020.
Anal fistula, with its complicated pathogenesis, has been considered as a clinical challenge for centuries. The risk of frequent recurrence and incontinence constitutes a considerable threat in the long-term treatment of anal fistula. In this work, we narratively reviewed the scientific literature of new techniques that have been used for anal fistula treatment over the recent 5 years, objectively evaluated the pros and cons of each technique on the basis of clinical outcomes, and tried to disclose the effective strategies for anal fistula treatment. Up to date, surgery is the main method used for treating anal fistula, but there is no simple technique that can completely heal complex anal fistula. In the course of surgery treatment, the healing outcome, and the protection of anal function should be weighed comprehensively. Among the innovative techniques that have emerged in recent years, combined techniques based on drainage Seton and LIFT-plug seem to be the relatively effective therapies, but their effectiveness requires more multi-center prospective randomized controlled trials with large sample size and long-term follow-up to be validated.
肛瘘发病机制复杂,几个世纪以来一直被视为临床挑战。频繁复发和失禁的风险在肛瘘的长期治疗中构成了相当大的威胁。在这项工作中,我们对近5年用于肛瘘治疗的新技术的科学文献进行了叙述性综述,根据临床结果客观评估了每种技术的优缺点,并试图揭示肛瘘治疗的有效策略。迄今为止,手术是治疗肛瘘的主要方法,但尚无简单技术能完全治愈复杂性肛瘘。在手术治疗过程中,应综合权衡愈合效果和肛门功能的保护。近年来出现的创新技术中,基于引流挂线和括约肌间瘘管结扎术-塞子的联合技术似乎是相对有效的治疗方法,但其有效性需要更多大样本量、长期随访的多中心前瞻性随机对照试验来验证。