瘘管切除术与失禁：我们真的需要担心吗？

Fistulectomy and incontinence: do we really need to worry?

作者信息

Maqbool Jahangeer, Mehraj Asif, Shah Zamir A, Aziz Gowhar, Wani Rauf A, Parray Fazl Q, Chowdri Nisar A

机构信息

Department of General Surgery (Colorectal Division), Sher I Kashmir Institute of Medical Sciences, Srinagar, India.

出版信息

Med Pharm Rep. 2022 Jan;95(1):59-64. doi: 10.15386/mpr-2045. Epub 2022 Jan 31.

DOI:10.15386/mpr-2045

PMID:35720244

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9177083/

Abstract

BACKGROUND

Anal fistula is often considered to be a dilemma because of the need to maintain a fine balance between postoperative incontinence and recurrence. We tried to find whether apprehension of causing incontinence should stop us from performing fistulectomy. The aim of this study was to determine whether fistulectomy was associated with increased rate of fecal incontinence and recurrence, compared to other procedures used for the treatment of anal fistula.

METHODS

It was a prospective, single center, observational study. All patients with anal fistula operated at a tertiary care teaching institute over a period of two years were included in the study. Recurrence rates and fecal incontinence were compared between patients subjected to fistulectomy and other procedures for treatment of fistula in ano.

RESULTS

A total of 124 patients with anal fistula were included. 92.8% patients were ≤ 60 years of age with high male preponderance (89.5%). Perineal discharge was the commonest complaint (95.96%). Intersphincteric (47.58%) followed by transphincteric fistulas (45.16%) accounted for the majority of fistulas. Fistulectomy was the most common procedure, performed in 90 (72.58%) patients. Incontinence occurred in 8/90 (8.88%) from the fistulectomy group and 2/34 (5.9%) patients in other surgery group, p=0.726. Recurrence occurred in 8/90 (8.88%) from the fistulectomy group and 8/34 (23.5%) patients from other surgery group, p=0.038. Overall rates of incontinence and recurrence were 8.1% and 12.9% respectively.

CONCLUSION

Fistulectomy, as compared to other procedures, results in less chances of recurrence without compromising continence.

摘要

背景

肛瘘常被视为一个难题，因为需要在术后失禁和复发之间保持微妙的平衡。我们试图探究对导致失禁的担忧是否应阻止我们进行瘘管切除术。本研究的目的是确定与用于治疗肛瘘的其他手术相比，瘘管切除术是否与大便失禁率和复发率的增加相关。

方法

这是一项前瞻性、单中心观察性研究。纳入了在一家三级护理教学机构接受肛瘘手术的所有患者，为期两年。比较了接受瘘管切除术的患者与其他治疗肛管肛瘘手术的患者的复发率和大便失禁情况。

结果

共纳入124例肛瘘患者。92.8%的患者年龄≤60岁，男性占比极高（89.5%）。会阴溢液是最常见的主诉（95.96%）。括约肌间肛瘘（47.58%）其次是经括约肌肛瘘（45.16%）占大多数。瘘管切除术是最常见的手术，90例（72.58%）患者接受了该手术。瘘管切除术组8/90（8.88%）患者出现失禁，其他手术组2/34（5.9%）患者出现失禁，p = 0.726。瘘管切除术组8/90（8.88%）患者复发，其他手术组8/34（23.5%）患者复发，p = 0.038。失禁和复发的总体发生率分别为8.1%和12.9%。