Ideal surgical treatment for anal fistula should aim to eradicate sepsis and promote healing of the tract,whilst preserving the sphincters and the mechanism of continence.For the simple and most distal fistulae,conven...Ideal surgical treatment for anal fistula should aim to eradicate sepsis and promote healing of the tract,whilst preserving the sphincters and the mechanism of continence.For the simple and most distal fistulae,conventional surgical options such as laying open of the fistula tract seem to be relatively safe and therefore,well accepted in clinical practise.However,for the more complex fistulae where a significant proportion of the anal sphincter is involved,great concern remains about damaging the sphincter and subsequent poor functional outcome,which is quite inevitable following conventional surgical treatment.For this reason,over the last twodecades,many sphincter-preserving procedures for the treatment of anal fistula have been introduced with the common goal of minimising the injury to the anal sphincters and preserving optimal function.Among them,the ligation of intersphincteric fistula tract procedure appears to be safe and effective and may be routinely considered for complex anal fistula.Another technique,the anal fistula plug,derived from porcine small intestinal submucosa,is safe but modestly effective in long-term follow-up,with success rates varying from 24%-88%.The failure rate may be due to its extrusion from the fistula tract.To obviate that,a new designed plug(GORE BioA ) was introduced,but long term data regarding its efficacy are scant.Fibrin glue showed poor and variable healing rate(14%-74%).Fi La C and video-assisted anal fistula treatment procedures,respectively using laser and electrode energy,are expensive and yet to be thoroughly assessed in clinical practise.Recently,a therapy using autologous adiposederived stem cells has been described.Their properties of regenerating tissues and suppressing inflammatory response must be better investigated on anal fistulae,and studies remain in progress.The aim of this present article is to review the pertinent literature,describing the advantages and limitations of new sphincterpreserving techniques.展开更多
目的比较肛瘘切开挂线术与括约肌间瘘管结扎术在肛瘘治疗中的临床疗效。方法选取2022年2月—2023年6月郯城县中医医院收治的80例肛瘘患者为研究对象,以随机数表法分为对照组和研究组,每组40例。对照组行肛瘘切开挂线术,研究组行括约肌...目的比较肛瘘切开挂线术与括约肌间瘘管结扎术在肛瘘治疗中的临床疗效。方法选取2022年2月—2023年6月郯城县中医医院收治的80例肛瘘患者为研究对象,以随机数表法分为对照组和研究组,每组40例。对照组行肛瘘切开挂线术,研究组行括约肌间瘘管结扎术。比较两组患者肛门功能、临床指标、生活质量。结果治疗3个月后,研究组耻骨直肠肌(motor unit potential,MUP)时限(6.86±1.23)ms、内括约肌MUP时限(7.19±1.61)ms、外括约肌MUP时限(6.42±1.29)ms均高于对照组,差异有统计学意义(t=3.567、2.386、3.429,P<0.05);研究组各项临床指标均小于对照组,差异有统计学意义(P<0.05),研究组生活质量评分高于对照组,差异有统计学意义(P<0.05)。结论括约肌间瘘管结扎术治疗肛瘘疗效较优,有助于改善患者临床各项指标,且对于患者肛门功能影响较小,从而能够提高患者的生活质量。展开更多
文摘Ideal surgical treatment for anal fistula should aim to eradicate sepsis and promote healing of the tract,whilst preserving the sphincters and the mechanism of continence.For the simple and most distal fistulae,conventional surgical options such as laying open of the fistula tract seem to be relatively safe and therefore,well accepted in clinical practise.However,for the more complex fistulae where a significant proportion of the anal sphincter is involved,great concern remains about damaging the sphincter and subsequent poor functional outcome,which is quite inevitable following conventional surgical treatment.For this reason,over the last twodecades,many sphincter-preserving procedures for the treatment of anal fistula have been introduced with the common goal of minimising the injury to the anal sphincters and preserving optimal function.Among them,the ligation of intersphincteric fistula tract procedure appears to be safe and effective and may be routinely considered for complex anal fistula.Another technique,the anal fistula plug,derived from porcine small intestinal submucosa,is safe but modestly effective in long-term follow-up,with success rates varying from 24%-88%.The failure rate may be due to its extrusion from the fistula tract.To obviate that,a new designed plug(GORE BioA ) was introduced,but long term data regarding its efficacy are scant.Fibrin glue showed poor and variable healing rate(14%-74%).Fi La C and video-assisted anal fistula treatment procedures,respectively using laser and electrode energy,are expensive and yet to be thoroughly assessed in clinical practise.Recently,a therapy using autologous adiposederived stem cells has been described.Their properties of regenerating tissues and suppressing inflammatory response must be better investigated on anal fistulae,and studies remain in progress.The aim of this present article is to review the pertinent literature,describing the advantages and limitations of new sphincterpreserving techniques.
文摘目的比较肛瘘切开挂线术与括约肌间瘘管结扎术在肛瘘治疗中的临床疗效。方法选取2022年2月—2023年6月郯城县中医医院收治的80例肛瘘患者为研究对象,以随机数表法分为对照组和研究组,每组40例。对照组行肛瘘切开挂线术,研究组行括约肌间瘘管结扎术。比较两组患者肛门功能、临床指标、生活质量。结果治疗3个月后,研究组耻骨直肠肌(motor unit potential,MUP)时限(6.86±1.23)ms、内括约肌MUP时限(7.19±1.61)ms、外括约肌MUP时限(6.42±1.29)ms均高于对照组,差异有统计学意义(t=3.567、2.386、3.429,P<0.05);研究组各项临床指标均小于对照组,差异有统计学意义(P<0.05),研究组生活质量评分高于对照组,差异有统计学意义(P<0.05)。结论括约肌间瘘管结扎术治疗肛瘘疗效较优,有助于改善患者临床各项指标,且对于患者肛门功能影响较小,从而能够提高患者的生活质量。
