改良汉利手术与改良汉利手术治疗高位复杂性马蹄形肛瘘的临床疗效比较：一项回顾性研究。

Comparison of clinical outcomes between remodified Hanley procedure and modified Hanley procedure for high complex horseshoe fistula: a retrospective study.

作者信息

Wang W, Cui W, Lu J, Yang M, Peng T, Yu J

机构信息

Department of Colorectal and Anal Surgery, Ningbo Medical Treatment Centre Li Huili Hospital, 1111 Jiangnan Road, Ningbo, 315000, People's Republic of China.

Li Huili Hospital of Ningbo University, Ningbo, 315000, People's Republic of China.

出版信息

Tech Coloproctol. 2024 Dec 21;29(1):33. doi: 10.1007/s10151-024-03072-5.

DOI:10.1007/s10151-024-03072-5

PMID:39708246

Abstract

BACKGROUND

Treating high horseshoe anal fistula (HHAF) with the modified Halley procedure (MHP) often falls short when focusing solely on deep postanal space (DPAS) drainage. Our study underscores the significance of addressing deep posterior intersphincteric space (DPIS) drainage, prompting MHP modifications.

METHODS

We studied consecutive patients with HHAF treated with either MHP or remodified-MHP (Re-MHP) at Ningbo Medical Center of Lihuili Hospital from January 2018 to December 2021. Postoperative outcomes, encompassing complications, cure rates, pain, anal incontinence, and quality of life, were retrospectively assessed.

RESULTS

Cure rates for MHP and Re-MHP were 95.3% (41/43) and 82.1% (32/39), respectively, without statistical significance (χ = 3.7, P = 0.08). VAS-PS, CCF-IS, and QLAF-QS scores significantly increased postsurgery and gradually decreased. Notably, Re-MHP demonstrated significantly lower VAS-PS scores during the first postoperative week, lower QLAF-QS scores on the seventh day, and more drainage secretions on the first day (P < 0.05).

CONCLUSION

Simultaneously enhancing DPAS and DPIS drainage in Re-MHP can enhance the cure rates of HHAF patients while preserving minimally invasive attributes.

摘要

背景

单纯采用改良哈雷手术（MHP）治疗高位马蹄形肛瘘（HHAF）时，若仅注重肛管后深间隙（DPAS）引流，往往效果欠佳。我们的研究强调了处理肛管后深括约肌间间隙（DPIS）引流的重要性，促使对MHP进行改良。

方法

我们研究了2018年1月至2021年12月在宁波市医疗中心李惠利医院接受MHP或改良后MHP（Re-MHP）治疗的连续性HHAF患者。对术后结果进行回顾性评估，包括并发症、治愈率、疼痛、肛门失禁和生活质量。

结果

MHP和Re-MHP的治愈率分别为95.3%（41/43）和82.1%（32/39），无统计学意义（χ = 3.7，P = 0.08）。视觉模拟评分法-疼痛评分（VAS-PS）、中国结直肠肛门外科失禁评分（CCF-IS）和肛瘘生活质量评分（QLAF-QS）术后显著升高，随后逐渐下降。值得注意的是，Re-MHP在术后第一周的VAS-PS评分显著更低，术后第七天的QLAF-QS评分更低，且术后第一天的引流分泌物更多（P < 0.05）。