Ozuner G, Hull T L, Cartmill J, Fazio V W
Department of Colotrectal Surgery, The Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA.
Dis Colon Rectum. 1996 Jan;39(1):10-4. doi: 10.1007/BF02048261.
Transanal rectal advancement flap (TRAF) is a surgical option in the management of rectovaginal and other complicated fistulas involving the anorectum. Most reported series have a short follow-up.
This study was undertaken to determine the long-term success, safety, applicability, and factors affecting recurrence in patients managed with TRAF, including patients with Crohn's disease.
METHODS/MATERIALS: Retrospective analysis of all patients undergoing endorectal advancement flaps at a single institution between 1988 and 1993 was performed. One hundred one patients were identified (70 percent female; 30 percent male). Included were 52 patients with rectovaginal, 46 with anal perineal, and 3 with rectourethral fistulas. Causes were obstetric injury in 13 patients, Crohn's disease in 47, cryptoglandular in 19, mucosal ulcerative colitis in 7, and surgical trauma or undefined causes in 15 patients.
No mortality occurred. Median follow-up was 31 (range, 1-79 months). Immediate failure (within one week of the repair) was seen in 6 percent of patients. Statistically (P<0.001) higher recurrence rates were observed in patients who had undergone previous repairs. Mean hospital stay was four days. Overall recurrence was seen in 29 patients (29 percent). Seventy-five percent of all recurrences occurred within the first 15 months; however, recurrence was noted for up to 55 months after repair. Etiology of fistula, use of constipating medications, antibiotic use, and most importantly associated Crohn's disease did not statistically affect recurrence rates. Failure rate was only influenced by previous number of repairs.
TRAF is a safe technique for managing complicated anorectal and rectovaginal fistulas, including patients with Crohn's disease. Long-term follow-up is essential to accurately report recurrence rates.
经肛门直肠推进皮瓣术（TRAF）是治疗直肠阴道瘘及其他累及肛管直肠的复杂瘘管的一种手术选择。大多数已报道的系列研究随访时间较短。
本研究旨在确定接受TRAF治疗的患者（包括克罗恩病患者）的长期成功率、安全性、适用性以及影响复发的因素。
方法/材料：对1988年至1993年间在单一机构接受直肠推进皮瓣术的所有患者进行回顾性分析。共确定了101例患者（70%为女性；30%为男性）。其中直肠阴道瘘患者52例，肛门会阴瘘患者46例，直肠尿道瘘患者3例。病因包括产科损伤13例，克罗恩病47例，隐窝腺性19例，黏膜溃疡性结肠炎7例，手术创伤或不明原因15例。
无死亡病例。中位随访时间为31个月（范围1 - 79个月）。6%的患者出现即刻失败（修复后1周内）。经统计学分析（P<0.001），既往接受过修复手术的患者复发率更高。平均住院时间为4天。29例患者（29%）出现总体复发。所有复发病例的75%发生在最初15个月内；然而，修复后长达55个月仍有复发病例。瘘管病因、使用便秘药物、使用抗生素，最重要的是合并克罗恩病，在统计学上均不影响复发率。失败率仅受既往修复次数影响。
TRAF是治疗包括克罗恩病患者在内的复杂肛管直肠瘘和直肠阴道瘘的一种安全技术。长期随访对于准确报告复发率至关重要。
