Athanasiadis S, Nafe M, Köhler A
Abteilung für Coloproktologie, St. Joseph-Hospital, Duisburg.
Langenbecks Arch Chir. 1995;380(1):31-6.
A prospective study was carried out on 55 patients with complicated anal fistulas (41 transsphincteric, 5 suprasphincteric and 9 rectovaginal) to evaluate the value of two sphincter-conserving techniques with primary occlusion of the internal ostium and endorectal advancement flap (group A, n = 34) or mucosal flap (group B, n = 21). Ten of the patients had Crohn's disease. Both techniques consist in one-stage fistulectomy without drainage of the intersphincteric space. The inflamed proctodeal and granulation tissue was carefully cleared. The site of the former primary orifice of the fistula was adapted by means of two or three peranally performed single stitches. The peranally applied suture included the layers of the internal anal sphincter muscle only. A mobilized flap of rectal wall (group A) and rectal mucosa and submucosa (group B) about 4 cm x 3 cm in size was stitched below the muscular sphincter. The perianal part of the wound was left to heal by second intention. Postoperatively there were 16 cases of suture leakage (23.5% in group A, and 38% in group B), and 19 patients (26% or 47% in both groups) had to have revision surgery because of recurrent fistula or sutur leakage; 2 patients (3.6%) developed incontinence with intermittent fecal soiling. Complete incontinence was not observed in any patient. No significant difference in clinical and functional results was determined between the two groups.
对55例复杂性肛瘘患者（41例经括约肌肛瘘、5例括约肌上肛瘘和9例直肠阴道瘘）进行了一项前瞻性研究，以评估两种保留括约肌技术的价值，这两种技术分别是内口一期封闭联合直肠推进皮瓣术（A组，n = 34）或黏膜瓣术（B组，n = 21）。其中10例患者患有克罗恩病。两种技术均包括一期瘘管切除术，不引流括约肌间间隙。仔细清除发炎的肛管和肉芽组织。通过两到三针经肛门的单针缝合来调整瘘管原内口的位置。经肛门应用的缝线仅包括肛门内括约肌层。将一块大小约4 cm×3 cm的直肠壁游离皮瓣（A组）以及直肠黏膜和黏膜下层（B组）缝合于肌肉括约肌下方。肛周伤口部分留待二期愈合。术后有16例出现缝线渗漏（A组为23.5%，B组为38%），19例患者（两组分别为26%或47%）因肛瘘复发或缝线渗漏而不得不接受修复手术；2例患者（3.6%）出现大便失禁伴间歇性粪便污染。未观察到任何患者出现完全性失禁。两组在临床和功能结果方面未发现显著差异。
