Department of Surgery, College of Health Sciences, University of Ghana Medical School, University of Ghana, Accra, Ghana.
Department of Surgery, Korle Bu Teaching Hospital, Accra, Ghana.
Colorectal Dis. 2022 Oct;24(10):1197-1203. doi: 10.1111/codi.16168. Epub 2022 May 24.
The aim of this work is to describe the clinicopathological and surgical aspects of fistula-in-ano and assess the risks associated with recurrence of the disease in a Ghanaian teaching hospital.
This was a retrospective observational study assessing all fistula-in-ano surgeries performed at the Korle Bu Teaching hospital from January 2014 to January 2021 that had completed follow up of at least 3 months after wound healing. Demographic, clinical, pathological and surgical data were extracted from patient records. Logistic regression analysis was used to test for association between these variables and recurrence.
A total of 105 patients underwent 124 fistula surgeries. Their median age was 41 years, the male:female ratio was 4:1 and 12 had comorbidities including human immunodeficiency virus infection and diabetes mellitus. Thirty-one per cent (39/124) of fistulas had previously been operated on. At surgery, 51% (64/124) of fistulas followed a single straight tract, 30% (37/124) a single curved tract and 19% (23/124) had multiple curved tracts. More than half (65/124) were trans-sphincteric, 35% (44/124) suprasphincteric, 10% (12/124) subsphincteric and 2% (3/124) were intersphincteric. Sixty per cent of fistulas were treated with a ligation of intersphincteric fistula tract (74/124), 35% (44/124) a fistulectomy and 5% a fistulotomy. Recurrence after surgery was 22.5% (28/124); this was significantly higher for fistulas with multiple curved tracts (OR 4.153, 95% CI 1.431-12.054, p = 0.012) and fistulas with comorbidities (OR 3.222, 95% CI 1.076-9.647, p = 0.037).
There was high recurrence after fistula surgery with increased risk for fistulas with multiple tracts and the presence of comorbidities.
本研究旨在描述肛门瘘的临床病理和手术方面，并评估加纳教学医院中该疾病复发的相关风险。
这是一项回顾性观察研究，评估了 2014 年 1 月至 2021 年 1 月期间在科勒布教学医院进行的所有肛门瘘手术，这些手术在伤口愈合后至少完成了 3 个月的随访。从病历中提取人口统计学、临床、病理和手术数据。使用逻辑回归分析来检验这些变量与复发之间的关联。
共有 105 名患者接受了 124 次瘘管手术。他们的中位年龄为 41 岁，男女比例为 4:1，12 名患者合并有人类免疫缺陷病毒感染和糖尿病等共病。31%（39/124）的瘘管曾接受过手术治疗。手术时，51%（64/124）的瘘管呈单一直线，30%（37/124）呈单一弯曲，19%（23/124）呈多弯曲。超过一半（65/124）为经括约肌瘘，35%（44/124）为经肛提肌上瘘，10%（12/124）为经肛提肌下瘘，2%（3/124）为括约肌间瘘。60%的瘘管采用括约肌间瘘管结扎术（74/124），35%（44/124）采用瘘管切除术，5%采用瘘管切开术。术后复发率为 22.5%（28/124）；多弯曲瘘（比值比 4.153，95%置信区间 1.431-12.054，p=0.012）和合并症（比值比 3.222，95%置信区间 1.076-9.647，p=0.037）的瘘管复发风险显著更高。
肛门瘘手术后复发率较高，多弯曲瘘和合并症的存在增加了复发的风险。
