新型经肛门内括约肌切开术在复杂肛瘘治疗中的应用。

Novel surgical procedure in design of advancement endorectal flap in the surgical treatment of complex anal fistulas.

出版信息

Rozhl Chir. 2023;102(10):387-394. doi: 10.33699/PIS.2023.102.10.387-394.

DOI:10.33699/PIS.2023.102.10.387-394

Abstract

INTRODUCTION

Anal fistula is a common disease with incidence of 5.6 per 100,000 women and 12.3 men. It is most often of cryptoglandular origin. The aim of this study is to evaluate our experience with patients treated for complex anal fistula with our own complex surgical procedure with advancement endorectal flap.

METHODS

524 patients with complex anal fistulas who were sent to our surgical clinic from January 2005 to the end of December 2022 were in- cluded in the study. We established the diagnosis by detecting the fistula tract by physical examination, anoscopy, probing the fistula tract and endorectal ultrasonography. We performed a complex operation together with the construction of the advancement endorectal flap in our own modification for all patients.

RESULTS

Primary surgical intervention in a group of 326 patients with complex anal fistulas (excluding patients with Crohn's disease) was successful in 283 (87%) patients. We identified advancement endorectal flap defect in the postoperative period in 17 (5.2%) patients, soiling in 16 (4.9%) and flatus incontinence in 9 (2.7%) patients. In a group of 120 patients after multiple surgeries (excluding patients with Crohn's disease), our surgical procedure was successful in 92 (76.6%) patients. In the postoperative period, we identified a advancement endorectal flap defect in 6 (5%) patients, soiling in 8 (6.6%) and flatus incontinence in 3 (2.5%) patients.

CONCLUSIONS

The construction of the advacement endorectal flap was curative and without affecting the level of anal continence in 87% of patients after primary surgical intervention and in 76.6% after multiple surgical procedures. Complex surgery with the construction of the advancement endorectal flap according to our procedure preserves the function of the sphincters and has a relatively low percentage of recurrences. The number of previous surgical interventions had no affect on the level of anal continence.

摘要

引言

肛门瘘是一种常见疾病，女性发病率为每 100,000 人 5.6 例，男性为 12.3 例。它最常源于隐匿性腺体。本研究旨在评估我们采用自行改良的经直肠内推进皮瓣复杂手术治疗复杂肛门瘘的经验。

方法

本研究纳入了 2005 年 1 月至 2022 年 12 月底期间因复杂肛门瘘被转诊至我们外科诊所的 524 例患者。我们通过体格检查、肛门镜检查、瘘管探查和经直肠超声检查来确定诊断。我们对所有患者均采用自行改良的经直肠内推进皮瓣复杂手术进行治疗。

结果

在一组 326 例（不包括克罗恩病患者）复杂肛门瘘患者中，初次手术干预成功 283 例（87%）。我们发现 17 例（5.2%）患者术后存在经直肠内推进皮瓣缺陷，16 例（4.9%）患者存在粪便污染，9 例（2.7%）患者存在气体失禁。在一组 120 例多次手术（不包括克罗恩病患者）患者中，我们的手术方法成功 92 例（76.6%）。术后，我们发现 6 例（5%）患者存在经直肠内推进皮瓣缺陷，8 例（6.6%）患者存在粪便污染，3 例（2.5%）患者存在气体失禁。