Gómez-Jurado M J, Martí-Gallostra M, Pellino G, Galvez A, Kreisler E, Biondo S, Espín-Basany E
Department of Advanced Medical and Surgical Sciences, Colorectal Surgery, Vall d'Hebron University Hospital, Barcelona, Spain.
Department of Advanced Medical and Surgical Sciences, Università Degli Studi Della Campania "Luigi Vanvitelli", Naples, Italy.
Tech Coloproctol. 2022 Jun;26(6):453-459. doi: 10.1007/s10151-022-02593-1. Epub 2022 Feb 25.
Effective, standardized treatments for complex anal fistula (CAF) still represent a clinical challenge. Emerging procedures attempted to achieve the healing rates of fistulotomy whilst preserving sphincter function. Acellular dermal matrix (ADM) used as a plug inserted through the fistulous tract is among newer treatment options. Varying success rates have been reported, most with short-term follow-up. The aim of this study was to report the long-term results of ADM-plug for CAF.
Retrospective analysis of a prospective database of patients treated with CAF. All consecutive patients presenting at two tertiary centers (Vall d'Hebron University Hospital and Bellvitge University Hospital, Barcelona, Spain) between November 2015 and March 2019 with a single, cryptoglandular CAF were evaluated for treatment with an ADM-plug were included. The primary endpoint was absence of discharge at clinical examination at 12 month follow-up.
Twenty-two patients were included [7 women and 15 men, median age 56 (33-74) years]. Most patients had high transsphincteric fistulas (63.6%). The median follow-up was 42 (21-53) months. The 12 month success rate was 68.2%, with an overall healing rate of 59.1%. 77.8% of recurrences occurred within 12 months from surgery. One plug extrusion was observed. No major complications or mortality occurred during the follow-up. Patients did not report any worsening of fecal continence.
This pilot study showed that more than half of patients with CAF could benefit from ADM-plug placement, preserving continence. A minimum follow-up of 12 months is recommended, because most recurrences occur during the first year.
复杂肛瘘（CAF）的有效、标准化治疗仍然是一项临床挑战。新出现的手术试图在保留括约肌功能的同时达到肛瘘切开术的愈合率。将脱细胞真皮基质（ADM）作为塞子经瘘管插入是较新的治疗选择之一。已报道的成功率各不相同，大多数是短期随访结果。本研究的目的是报告ADM塞子治疗CAF的长期结果。
对CAF治疗患者的前瞻性数据库进行回顾性分析。纳入2015年11月至2019年3月期间在两个三级中心（西班牙巴塞罗那的瓦尔德希伯伦大学医院和贝尔维奇大学医院）就诊的所有连续的、患有单一隐窝腺源性CAF且接受ADM塞子治疗评估的患者。主要终点是在12个月随访的临床检查中无分泌物。
纳入22例患者[7例女性和15例男性，中位年龄56（33 - 74）岁]。大多数患者患有高位经括约肌肛瘘（63.6%）。中位随访时间为42（21 - 53）个月。12个月成功率为68.2%，总体愈合率为59.1%。77.8%的复发发生在术后12个月内。观察到1例塞子挤出。随访期间未发生重大并发症或死亡。患者未报告大便失禁有任何恶化。
这项前瞻性研究表明，超过一半的CAF患者可从ADM塞子置入中获益，并保留了控便能力。建议至少随访12个月，因为大多数复发发生在第一年。
