目的:探讨虚实结合挂线法对高位复杂性肛瘘患者术后创面愈合及肛门功能的影响。方法:选取2016年10月至2018年8月收治的75例高位复杂性肛瘘患者作为研究对象,根据治疗方法不同分为两组:对照组(30例)采用内口上方实挂线法治疗,观察组(45例...目的:探讨虚实结合挂线法对高位复杂性肛瘘患者术后创面愈合及肛门功能的影响。方法:选取2016年10月至2018年8月收治的75例高位复杂性肛瘘患者作为研究对象,根据治疗方法不同分为两组:对照组(30例)采用内口上方实挂线法治疗,观察组(45例)采用虚实结合挂线法治疗。比较两组治愈率、术后3个月复发率,瘢痕面积,创面愈合时间,术后大便失禁严重度评分表(Wexner),术后1、3、5、7 d视觉模拟评分(VAS)等指标。结果:观察组和对照组的治愈率、术后3个月复发率分别为97.78%、2.22%和100.00%、0,两组比较,差异无统计学意义(P>0.05);观察组瘢痕面积、创面愈合时间、Wexner评分低于对照组(P<0.05);观察组术后1、3、5、7 d VAS评分均低于对照组(P<0.05)。结论:虚实结合挂线法是治疗高位复杂性肛瘘的有效方法,能减轻术后疼痛,减少瘢痕面积,促进创面愈合,保护肛门功能,应用价值较高。展开更多
AIM: To prospectively perform the PERFACT procedure in supralevator anal fistula/abscess.METHODS: Magnetic resonance imaging was done preoperatively in all the patients. Proximal cauterization around the internal open...AIM: To prospectively perform the PERFACT procedure in supralevator anal fistula/abscess.METHODS: Magnetic resonance imaging was done preoperatively in all the patients. Proximal cauterization around the internal opening, emptying regularly of fistula tracts and curettage of tracts(PERFACT) was done in all patients with supralevator fistula or abscess. All types of anal fistula and/or abscess with supralevator extension, whether intersphincteric or transsphincteric, were included in the study. The internal opening along with the adjacent mucosa was electrocauterized. The resulting wound was left open to heal by secondary intention so as to heal(close) the internal opening by granulation tissue. The supralevator tract/abscess was drained and thoroughly curetted. It was regularly cleaned and kept empty in the postoperative period. The primary outcome parameter was complete fistula healing. The secondary outcome parameters were return to work and change in incontinence scores(Vaizey objective scoring system) assessed preoperatively and at 3 mo after surgery.RESULTS: Seventeen patients were prospectively enrolled and followed for a median of 13 mo(range 5-21 mo). Mean age was 41.1 ± 13.4 years, M:F-15:2. Fourteen(82.4%) had a recurrent fistula, 8(47.1%) had an associated abscess, 14(82.4%) had multiple tracts and 5(29.4%) had horseshoe fistulae. Infralevator part of fistula was intersphincteric in 4 and transsphincteric in 13 patients. Two patients were excluded. Eleven out of fifteen(73.3%) were cured and 26.7%(4/15) had a recurrence. Two patients with recurrence were reoperated on with the same procedure and one was cured. Thus, the overall healing rate was 80%(12/15). All the patients could resume normal work within 48 h of surgery. There was no deterioration in incontinence scores(Vaizey objective scoring system). This is the largest series of supralevator fistula-in-ano(SLF) published to date. CONCLUSION: PERFACT procedure is an effective single step sphincter saving procedure to treat SLF with minimal risk of 展开更多
目的系统评价视频辅助肛瘘治疗术治疗复杂性肛瘘的疗效和安全性。方法检索中国知网、万方、维普、中国生物医学文献数据库、Web of Science、PubMed、Cochrane Library及Embase数据库,时间范围从建库截止到2022年5月31日;由两位研究者...目的系统评价视频辅助肛瘘治疗术治疗复杂性肛瘘的疗效和安全性。方法检索中国知网、万方、维普、中国生物医学文献数据库、Web of Science、PubMed、Cochrane Library及Embase数据库,时间范围从建库截止到2022年5月31日;由两位研究者独立筛选文献,并根据研究目的和质量评价标准对符合纳入标准的文献进行质量评价;使用RevMan 5.4.1软件进行meta分析。结果研究纳入了11篇文献,共977例患者。meta分析结果显示:视频辅助组在提高治愈率[RR=1.14,95%CI为(1.04,1.24),P<0.05],加速创面愈合[MD=–10.40,95%CI为(–13.64,–7.17),P<0.05],保护术后肛门功能[MD=–1.32,95%CI为(–1.85,–0.79),P<0.05],缓解术后24 h疼痛[MD=–1.23,95%CI为(–1.60,–0.86),P<0.05],缩短手术时间[MD=–9.46,95%CI为(–17.16,–1.75),P<0.05]和住院时间[MD=–3.87,95%CI为(–5.90,–1.84),P<0.05],减少术中出血量[MD=–14.24,95%CI为(–17.49,–10.99),P<0.05]以及降低术后并发症发生率[RR=0.39,95%CI为(0.27,0.56),P<0.05]均优于切开挂线组,差异具有统计学意义。而术后1年复发率[OR=0.64,95%CI为(0.33,1.23),P>0.05]2组间差异无统计学意义。结论视频辅助肛瘘治疗术是治疗复杂性肛瘘的一种安全、有效的保留括约肌术式,优于传统切开挂线术。但由于纳入的文献存在一定的局限性和发表偏倚,临床上需要更多的前瞻性、大样本、多中心的随机对照试验来证实其远期疗效。展开更多
文摘目的:探讨虚实结合挂线法对高位复杂性肛瘘患者术后创面愈合及肛门功能的影响。方法:选取2016年10月至2018年8月收治的75例高位复杂性肛瘘患者作为研究对象,根据治疗方法不同分为两组:对照组(30例)采用内口上方实挂线法治疗,观察组(45例)采用虚实结合挂线法治疗。比较两组治愈率、术后3个月复发率,瘢痕面积,创面愈合时间,术后大便失禁严重度评分表(Wexner),术后1、3、5、7 d视觉模拟评分(VAS)等指标。结果:观察组和对照组的治愈率、术后3个月复发率分别为97.78%、2.22%和100.00%、0,两组比较,差异无统计学意义(P>0.05);观察组瘢痕面积、创面愈合时间、Wexner评分低于对照组(P<0.05);观察组术后1、3、5、7 d VAS评分均低于对照组(P<0.05)。结论:虚实结合挂线法是治疗高位复杂性肛瘘的有效方法,能减轻术后疼痛,减少瘢痕面积,促进创面愈合,保护肛门功能,应用价值较高。
文摘AIM: To prospectively perform the PERFACT procedure in supralevator anal fistula/abscess.METHODS: Magnetic resonance imaging was done preoperatively in all the patients. Proximal cauterization around the internal opening, emptying regularly of fistula tracts and curettage of tracts(PERFACT) was done in all patients with supralevator fistula or abscess. All types of anal fistula and/or abscess with supralevator extension, whether intersphincteric or transsphincteric, were included in the study. The internal opening along with the adjacent mucosa was electrocauterized. The resulting wound was left open to heal by secondary intention so as to heal(close) the internal opening by granulation tissue. The supralevator tract/abscess was drained and thoroughly curetted. It was regularly cleaned and kept empty in the postoperative period. The primary outcome parameter was complete fistula healing. The secondary outcome parameters were return to work and change in incontinence scores(Vaizey objective scoring system) assessed preoperatively and at 3 mo after surgery.RESULTS: Seventeen patients were prospectively enrolled and followed for a median of 13 mo(range 5-21 mo). Mean age was 41.1 ± 13.4 years, M:F-15:2. Fourteen(82.4%) had a recurrent fistula, 8(47.1%) had an associated abscess, 14(82.4%) had multiple tracts and 5(29.4%) had horseshoe fistulae. Infralevator part of fistula was intersphincteric in 4 and transsphincteric in 13 patients. Two patients were excluded. Eleven out of fifteen(73.3%) were cured and 26.7%(4/15) had a recurrence. Two patients with recurrence were reoperated on with the same procedure and one was cured. Thus, the overall healing rate was 80%(12/15). All the patients could resume normal work within 48 h of surgery. There was no deterioration in incontinence scores(Vaizey objective scoring system). This is the largest series of supralevator fistula-in-ano(SLF) published to date. CONCLUSION: PERFACT procedure is an effective single step sphincter saving procedure to treat SLF with minimal risk of
