Hämäläinen K P, Sainio A P
Fourth Department of Surgery, Helsinki University Central Hospital, Finland.
Dis Colon Rectum. 1997 Dec;40(12):1443-6; discussion 1447. doi: 10.1007/BF02070710.
Long-term results of cutting seton in the treatment of anal fistulas were studied.
Of the 44 patients with anal fistulas, mainly of the high variety, managed with this method, 35 (25 men) attended a clinical and manometric follow-up examination on average 70 (range, 28-184) months after operation. Fistula distribution was high transsphincteric (25), low transsphincteric (5), extrasphincteric (3), and suprasphincteric (2). The seton was tightened at one-week to two-week intervals to achieve gradual sphincter division.
Time required to achieve complete fistula healing ranged from 37 to 557 (mean, 151) days. Two (6 percent) of the 35 patients re-examined had recurrence of fistula and 22 (63 percent) reported symptoms of minor impairment in anal control, which in four patients had existed already before operation. Anal resting pressures were similar for defective and normal control, but other manometric variables were inferior in incontinence, although total squeeze pressure only showed statistically significant difference from normal continence (P = 0.0345). Incontinence was likely associated with hard and gutter-shaped operation scars in the anal canal, but the difference from normal continence was not statistically significant.
Cutting seton yields fairly good results in regard to cure of fistula, but the risk of anal incontinence, despite its minor degree, seems to be too high to recommend its routine use for all high fistulas. The suprasphincteric fistulas and some extrasphincteric fistulas are difficult to treat otherwise, but especially for high transsphincteric fistulas, other methods of treatment (preferably those in which sphincter division can be avoided and the risk of anal canal deformity and incontinence are minimized) are advocated.
研究切开挂线疗法治疗肛瘘的长期疗效。
采用该方法治疗44例肛瘘患者，主要为高位肛瘘。其中35例（25例男性）在术后平均70个月（范围28 - 184个月）接受了临床和测压随访检查。肛瘘分布为高位经括约肌型（25例）、低位经括约肌型（5例）、括约肌外瘘（3例）和括约肌上瘘（2例）。挂线每隔1 - 2周收紧一次，以实现括约肌的逐渐离断。
肛瘘完全愈合所需时间为37至557天（平均151天）。35例复查患者中有2例（6%）肛瘘复发，22例（63%）报告有肛门控便轻度受损症状，其中4例在手术前就已存在该症状。肛门静息压在有控便功能缺陷和正常对照组中相似，但其他测压变量在失禁组中较差，尽管总挤压压与正常控便组相比仅显示出统计学显著差异（P = 0.0345）。失禁可能与肛管内坚硬且呈沟状的手术瘢痕有关，但与正常控便组的差异无统计学意义。
切开挂线疗法在肛瘘治愈方面取得了较好的效果，但肛门失禁的风险尽管程度较轻，似乎过高，不建议对所有高位肛瘘常规使用。括约肌上瘘和一些括约肌外瘘难以用其他方法治疗，但特别是对于高位经括约肌型肛瘘，提倡采用其他治疗方法（最好是那些可避免括约肌离断且能将肛管畸形和失禁风险降至最低的方法）。
