Christiansen J, Rønholt C
Department of Surgery D, Herlev Hospital, University of Copenhagen, Denmark.
Int J Colorectal Dis. 1995;10(4):207-9. doi: 10.1007/BF00346220.
Fourteen patients with recurrent high anal fistula were treated by total excision of the fistulous tract with primary sphincter reconstruction. Nine patients with sepsis had seton drainage for one to three months before the operation. The surgical approach was the transsphincteric technique described by Mason. No covering stoma was used routinely, but three patients referred with a colostomy had the stoma closed 3 to 5 months later. After a follow-up from 1 to 4 years two patients had recurrence, which in one necessitated a diverting ileostomy. Three patients, one with recurrence and two without, suffered from minor anal incontinence. It is concluded that total excision with primary sphincter reconstruction is a treatment modality which should be considered for recurrent high anal fistula, especially in patients where closure by an advancement flap is not possible.
14例复发性高位肛瘘患者接受了瘘管全切除及一期括约肌重建术治疗。9例伴有脓毒症的患者在手术前先行挂线引流1至3个月。手术方法采用Mason描述的经括约肌技术。通常不常规使用覆盖造口，但3例伴有结肠造口的患者在3至5个月后关闭了造口。经过1至4年的随访，2例患者复发，其中1例需要行转流性回肠造口术。3例患者存在轻度肛门失禁，其中1例复发，2例未复发。结论是，瘘管全切除及一期括约肌重建术是复发性高位肛瘘应考虑的一种治疗方式，尤其是在无法采用推进皮瓣闭合的患者中。
