Van Tets W F, Kuijpers J H
Department of Surgery, University Hospital Nijmegen, Netherlands.
Br J Surg. 1995 Jul;82(7):895-7. doi: 10.1002/bjs.1800820711.
Staged fistulotomy with a seton is considered to decrease the high incidence of continence disorders after surgical incision of a fistula. This retrospective study reports the results of the two-stage procedure with special emphasis on faecal continence. Thirty-four patients (aged between 20 and 57 years) were treated between 1981 and 1990 with a two-stage seton procedure for anal fistula (16 extrasphincteric and 18 trans-sphincteric) with a high anal or rectal internal opening. Thirty-one patients had normal preoperative continence. There were two recurrences. All trans-sphincteric fistulas healed. Twenty-nine patients with preoperative normal faecal control were available for follow-up. Postoperative continence was normal in 12 patients (category A according to Browning and Parks classification2); five patients had no control over flatus (B), 11 were incontinent for liquid stool or flatus (C) and one had continued faecal leakage (D). The two-stage seton technique is not recommended for fistulas with high anal or rectal openings.
分期挂线瘘管切开术被认为可降低瘘管手术切开后大便失禁的高发生率。这项回顾性研究报告了两阶段手术的结果，特别强调了大便失禁情况。1981年至1990年间，34例患者（年龄在20至57岁之间）接受了两阶段挂线手术治疗肛瘘（16例括约肌外肛瘘和18例括约肌间肛瘘），肛门或直肠内口较高。31例患者术前大便失禁情况正常。有2例复发。所有括约肌间肛瘘均愈合。29例术前大便控制正常的患者可供随访。12例患者术后大便失禁情况正常（根据Browning和Parks分类法为A类）；5例患者对排气无控制能力（B类），11例患者对稀便或排气失禁（C类），1例患者持续存在粪便渗漏（D类）。对于肛门或直肠开口较高的肛瘘，不建议采用两阶段挂线技术。
