Pearl R K, Andrews J R, Orsay C P, Weisman R I, Prasad M L, Nelson R L, Cintron J R, Abcarian H
Section of Colon and Rectal Surgery, Cook County Hospital, Chicago, Illinois 60612.
Dis Colon Rectum. 1993 Jun;36(6):573-7; discussion 577-9. doi: 10.1007/BF02049864.
To identify the incidence of major fecal incontinence and recurrence after staged fistulotomy using a seton.
A five-year retrospective chart review of 116 patients (70 males and 46 females) ranging in age from 18 to 81 years (mean, 42 years), in whom setons were placed as part of a surgical procedure for anorectal fistulas, was carried out. Follow-up ranged from 2 to 61 months (mean, 23 months).
Setons were employed to identify and promote fibrosis around a complex anorectal fistula as part of a staged fistulotomy in 65 patients (56 percent). Other indications for seton placement included 24 women with anteriorly situated high transsphincteric fistulas (21 percent) and three patients with massive anorectal sepsis (floating, freestanding anus) (2.5 percent). In addition, setons were used to preclude premature skin closure and promote controlled long-term fistula drainage in 21 patients with severe anorectal Crohn's disease (18 percent) and in three patients with AIDS (2.5 percent). Major fecal incontinence (requiring the use of a perineal pad) occurred in five patients (5 percent), and recurrent fistulas were noted in three (3 percent).
Staged fistulotomy using a seton is a safe and effective method of treating high or complicated anorectal fistulas.
确定使用挂线分期肛瘘切开术后大便失禁及复发的发生率。
对116例年龄在18至81岁（平均42岁）的患者（70例男性和46例女性）进行了为期五年的回顾性病历审查，这些患者接受了挂线治疗，挂线是作为肛瘘手术的一部分。随访时间为2至61个月（平均23个月）。
65例患者（56%）采用挂线来识别并促进复杂肛瘘周围的纤维化，作为分期肛瘘切开术的一部分。放置挂线的其他适应证包括24例患有前位高位经括约肌肛瘘的女性（21%）和3例患有严重肛门直肠脓毒症（浮动性、孤立性肛门）的患者（2.5%）。此外，21例严重肛门直肠克罗恩病患者（18%）和3例艾滋病患者（2.5%）使用挂线以防止过早的皮肤闭合并促进瘘管的长期可控引流。5例患者（5%）发生了严重大便失禁（需要使用会阴垫），3例（3%）出现了复发性肛瘘。
使用挂线分期肛瘘切开术是治疗高位或复杂性肛瘘的一种安全有效的方法。
