Maria G, Brisinda G, Civello I M
Department of Surgery, Catholic University of Rome, Italy.
Am J Surg. 1998 Feb;175(2):158-60. doi: 10.1016/S0002-9610(97)00266-3.
Cicatricial stenosis of the anal canal is a disabling complication of anal surgery. Many different surgical techniques have been described for the management of this disorder.
In this study we report 42 patients with severe anal stricture treated with anoplasty. Twenty-nine of these patients underwent a Y-V anoplasty while 13 had a diamond flap anoplasty. All patients were seen 4 weeks, 6 months, and 2 years after surgery.
Three patients who had undergone Y-V anoplasty experienced, as a minor early operative complication, a suture dehiscence and 1 patient had an ischemic contracture of the leading edge of the flap. Two patients had urinary infections. None of these complications needed further surgical intervention and were all managed with local and medical therapy. At 2 years follow-up 93% of patients had been successfully treated while the remaining 7% had improved. Fifteen percent of patients who had undergone Y-V anoplasty complained of postoperative complications, and all patients with incomplete results had been treated with an Y-V anoplasty.
Based on our cohort of patients we believe that both techniques are satisfactory in treating anal stricture but diamond flap anoplasty seems more reliable because of the reduced tension at the suture line and the better blood supply to the flap.
肛管瘢痕性狭窄是肛门手术致残性并发症。已有多种不同手术技术用于治疗该疾病。
本研究报告42例接受肛门成形术治疗的重度肛门狭窄患者。其中29例患者接受Y-V肛门成形术，13例接受菱形皮瓣肛门成形术。所有患者在术后4周、6个月和2年进行随访。
3例接受Y-V肛门成形术的患者出现缝线裂开这一轻微早期手术并发症，1例患者皮瓣前缘出现缺血性挛缩。2例患者发生尿路感染。这些并发症均无需进一步手术干预，均通过局部和药物治疗处理。随访2年时，93%的患者得到成功治疗，其余7%的患者病情有所改善。接受Y-V肛门成形术的患者中有15%抱怨术后出现并发症，所有治疗效果不完全的患者均接受了Y-V肛门成形术治疗。
基于我们的患者队列，我们认为两种技术在治疗肛门狭窄方面均令人满意，但菱形皮瓣肛门成形术似乎更可靠，因为缝合线处张力降低且皮瓣血供更好。
