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1.
目的探讨低位微创切口高位虚挂线术治疗高位肛瘘的临床疗效。方法回顾性分析2008年01月至2011年12月江西省全南县人民医院收治的96例接受手术治疗的高位肛瘘患者的临床资料,其中行低位微创切口高位虚挂线手术58例(治疗组),传统低位切开高位挂线术38例(对照组)。结果治疗组患者手术时间、术后创面愈合时间及住院时间较对照组明显缩短(P〈0.05);治疗组患者中出血量比对照组少(P〈0.05);治疗组患者术后肛门疼痛较对照组明显减轻(P〈0.05);术后1个月和6个月治疗组Wexner评分分别为(1.80±0.77)和(1.00±0.64),与对照组的(2.50±0.62)和(1.60±0.77)相比,差异有统计学意义(P〈0.05)。结论低位微创切口高位虚挂线治疗高位肛瘘更有效,患者术后恢复更快。 相似文献
2.
《Journal of pediatric surgery》2023,58(7):1274-1280
BackgroundPerianal abscesses and anal fistulas are common. The principle of intention-to-treat has not been considered in previous systemic reviews. Thus, the comparison between primary and post-recurrence management was confused, and the recommendation of primary treatment is obscure. The current study aims to identify the optimal initial treatment for pediatric patients.MethodsUsing PRISMA guidelines, studies were identified from MEDLINE, EMBASE, PubMed, Cochrane Library, and Google Scholar without any language or study design restriction. The inclusion criteria include original articles or articles with original data, studies of management for a perianal abscess with or without anal fistula, and patient age of <18 years. Patients with local malignancy, Crohn's disease, or other underlying predisposing conditions were excluded. Studies without analyzing recurrence, case series of <5, and irrelevant articles were excluded in the screening stage. Of the 124 screened articles, 14 articles had no full texts or detailed information. Articles written in a language other than English or Mandarin were translated by Google Translation first and confirmed with native speakers. After the eligibility process, studies that compared identified primary managements were then included in the qualitative synthesis.ResultsThirty-one studies involving 2507 pediatric patients met the inclusion criteria. The study design consisted of two prospective case series of 47 patients and retrospective cohort studies. No randomized control trials were identified. Meta-analyses for recurrence after initial management were performed with a random-effects model. Conservative treatment and drainage revealed no difference (Odds ratio [OR], 1.222; 95% Confidential interval [CI]: 0.615–2.427, p = 0.567). Conservative management had a higher risk of recurrence than surgery without statistical significance (OR 0.278, 95% CI: 0.109–0.707, p = 0.007). Compared with incision/drainage, surgery can prevent recurrence remarkably (OR 4.360, 95% CI: 1.761–10.792, p = 0.001). Subgroup analysis of different approaches within conservative treatment and operation was not performed for lacking information.ConclusionStrong recommendations cannot be made due to the lack of prospective or randomized controlled studies. However, the current study based on real primary management supports initial surgical intervention for pediatric patients with perianal abscesses and anal fistula to prevent recurrence.Level of evidenceType of study: Systemic review; Evidence level: Level II. 相似文献
3.
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目的 了解经肛门超声内镜检查对内口已经愈合的肛瘘病人内口部位的诊断价值。方法 对临床常规手术未能发现肛瘘内口的12例病人进行超声内镜检查,并进行手术治疗。分析经肛门超声内镜检查对内口已经愈合的肛瘘病人内口部位的诊断价值和超声影像学特点,并与其它常规检查方法比较。结果 内镜超声检查在12例病 人均发现已经愈合的内口的准确位置,准确性优于Goodsall规律、肛门直肠肛门指诊、窦道造影或美蓝注射以及窦道探针探查。结论 经肛瘘外口位置注射美蓝,可方便手术医师快速定位内口。经肛门超声内镜检查是定位已经愈合的肛瘘内口的准确、快速、简单、耐受性好的检查手段。在超声内镜发现内口后,经内镜在内口位置注射美蓝,可方便手术医师快速定位内口。 相似文献
4.
Patient satisfaction after surgical treatment for fistula-in-ano 总被引:7,自引:3,他引:4
García-Aguilar J Davey CS Le CT Lowry AC Rothenberger DA 《Diseases of the colon and rectum》2000,43(9):1206-1212
PURPOSE: The surgical treatment of fistula-in-ano frequently results in recurrence of the fistula or postoperative anal incontinence. Despite these problems, most patients are satisfied with the results of their surgery. To clarify this apparent discrepancy, we attempted to identify factors that affect patient's lifestyles and may contribute to their satisfaction. METHODS: A questionnaire was mailed to 624 patients surgically treated for cryptoglandular fistula-in-ano at the University of Minnesota during a five-year period. Three hundred seventy-five patients returned their questionnaires. Patients who were followed up for a minimum of one year were included in this retrospective study. Associations between postoperative complications and patient satisfaction were identified by chi-squared tests and multiple logistic regression. Attributable fractions for patient dissatisfaction were calculated using study population dissatisfaction rates. RESULTS: Patient satisfaction was strongly associated with fistula recurrence, difficulty holding gas, soiling of undergarment, and accidental bowel movements. Effects of incontinence on patient quality of life were also significantly associated with patient satisfaction as was the number of lifestyle activities affected by incontinence. Patients with fistula recurrence reported a higher dissatisfaction rate (61 percent) than did patients with anal incontinence (24 percent), but the attributable fraction of dissatisfaction for incontinence (84 percent) was greater than that for fistula recurrence (33 percent). Patient satisfaction was not significantly associated with age, gender, history of previous fistula surgery, type of fistula, surgical procedure, time since surgery, or operating surgeon. CONCLUSION: Patient satisfaction after surgical treatment for fistula-in-ano is associated with recurrence of the fistula, the development of anal incontinence, and with the effects of anal incontinence on patient lifestyle. In our series of patients treated mainly with laying open of the fistula tract, patients with fistula recurrence had a higher dissatisfaction rate than did patients with anal incontinence. However, because anal incontinence was more prevalent than fistula recurrence, a higher fraction of dissatisfaction was attributable to anal incontinence.Presented at the meeting of the Association of Coloproctology of Great Britain and Ireland, Brighton, United Kingdom, July 10 to 12, 2000. 相似文献
5.
How can the assessment of fistula-in-ano be improved? 总被引:5,自引:4,他引:5
Ratto C Gentile E Merico M Spinazzola C Mangini G Sofo L Doglietto G 《Diseases of the colon and rectum》2000,43(10):1375-1382
PURPOSE. Fistula-in-ano anatomy and its relationship with anal sphincters are important factors influencing the results of surgical management. Preoperative definition of fistulous track(s) and the internal opening play a primary role in minimizing iatrogenic damage to the sphincters and recurrence of the fistula. METHODS. Physical examination and endoanal ultrasound (performed with a 10 MHz endoprobe), either conventionally or with an injection of hydrogen peroxide, were performed in 26 consecutive patients. Results were matched with surgical features to establish their accuracy in preoperative fistula-in-ano assessment. RESULTS. Accuracy rates of clinical examination endoanal ultrasound, and hydrogen peroxide-enhanced ultrasound were 65.4, 50, and 76.9 percent for primary tracks, 73.1, 65.4, and 88.5 percent for secondary tracks, and 80.8, 80.8, and 92.3 percent for horseshoe extensions, respectively. Compared with physical examination and endoanal ultrasound, accuracy of hydrogen peroxide-enhanced ultrasound was higher for transsphincteric and intersphincteric primary tracks and horseshoe extensions. Both endoanal ultrasound and hydrogen peroxide-enhanced ultrasound displayed a significantly higher accuracy in detecting the internal openings (53.8 and 53.8 percent, respectively) compared with clinical evaluation (23.1 percent;P=0.027). CONCLUSIONS. Our data suggest that hydrogen peroxide-enhanced ultrasound can be very reliable and useful in the definition of fistula anatomy, its relationship with anal sphincters, and, hence, surgical strategy. It also improves identification of secondary extensions, particularly horseshoe tracks. This method, besides being safe, economic and reputable, both preoperatively and postoperatively, could be helpful in checking operative results and recurrence.Presented at The American Society of Colon and Rectal Surgeons' 100th Anniversary and Tripartite Meeting, Washington, D.C., May 1 to 6, 1999. 相似文献
6.
7.
Perez F Arroyo A Serrano P Sánchez A Candela F Perez MT Calpena R 《American journal of surgery》2006,192(1):34-40
BACKGROUND: The goal of this study was to compare the outcomes of advancement flap (AF) versus fistulotomy with sphincter reconstruction (FSR) for primary complex fistula-in-ano in terms of recurrence and anal function. METHODS: A randomized clinical trial was conducted to compare AF with FSR. Preoperative and postoperative evaluation included physical examination, anal ultrasonography, and anal manometry, with a minimum follow-up period of 24 months. Anal continence was evaluated using the Wexner Continence Grading Scale (scale, 0-20). RESULTS: Sixty patients were randomized to AF (group 1, N = 30) or FSR (group 2, N = 30). Three patients from group 1 and 2 patients from group 2 were excluded from the study because of active sepsis at surgery. Fistulas were classified as high transsphincteric in 44 patients (80%) and suprasphincteric in 11 patients (20%). Demographic and clinical features showed no differences between the 2 groups. The mean Wexner Continence Grading Scale did not vary significantly after surgery in either group, and there was no difference between the groups. On anal manometry there was a significant decrease in the maximum resting pressure after surgery in both groups, and in the maximum squeeze pressure in the AF group, but neither the maximum resting pressure nor the maximum squeeze pressure differed significantly between groups, either before or after surgery. Two fistulas from each group recurred after surgery (7.4% and 7.1%, respectively). The mean follow-up period was 36 months (range, 24-52 mo). CONCLUSIONS: FSR compares with AF in terms of postoperative continence and recurrence. Anal continence and manometric values are not jeopardized in either technique. 相似文献
8.
Background Accurate delineation of anal fistula
anatomy in recurrent cases will assist in surgical fistula
eradication whilst preserving continence. Recently,
transperineal ultrasonography (TPUS) has been used in
perirectal inflammation where there may be advantage
over endoanal ultrasonography (EAUS) in complex fistulae-
in-ano which lie outside the focal range of the endoanal
probe. We assessed the sensitivity of these two imaging
modalities to characterize fistula-in-ano, compared to surgical
findings.
Methods Hand-held 7.5 MHz TPUS was
performed in the axial and sagittal planes in never-operated
(Group 1, n=10) and recurrent (Group 2, n=10) cryptogenic
fistulae where the ultrasonographer was blinded to
the initial operative findings. This was compared with
hydrogen peroxide-enhanced EAUS using a 7.5 MHz
rotating probe, assessing the fistula anatomy, site of the
internal opening, confirmation of Goodsall’s rule and the
presence of secondary tracks, abscess collections and significant
horsehoeing of the track.
Results Overall sensitivity
for the detection of trans-sphincteric and extrasphincteric
fistulae was 100% using both techniques with a 90%
sensitivity for TPUS and an 85% sensitivity for EAUS in
the prediction of the internal fistula opening site. The
TPUS sensitivity for horseshoeing was poor (28.6%) as
was the detection of ancillary abscesses confirmed at
surgery (63.6%) but TPUS demonstrated rectovaginal fistulae.
Conclusion TPUS is a novel technique for use in
perirectal infection which has a significant learning curve
but which is highly accurate for prediction of the anatomy
of complex recurrent as well as simple anal fistulae.
An erratum to this article is available at . 相似文献
9.
Davies M Harris D Lohana P Chandra Sekaran TV Morgan AR Beynon J Carr ND 《International journal of colorectal disease》2008,23(9):833-838
INTRODUCTION: Fistula-in-ano can be associated with a number of conditions, including Crohn's disease. The majority, however, are classified as idiopathic or cryptoglandular. The aim of this study was to review the outcome of surgical management of fistula-in-ano in a specialist colorectal unit. MATERIALS AND METHODS: One hundred and four consecutive patients underwent surgery for anal fistulae between 1st January 2000 and December 2004. Data was analysed in two main groups, according to the aetiology, cryptoglandular (n = 86) and Crohn's disease (n = 18). Follow-up data was available on 91 patients. RESULTS: In the cryptoglandular group, 62 patients had an inter-sphincteric tract, of which 48 underwent a single-stage fistulotomy. Of those patients with a trans-sphincteric tract, six patients underwent a single-stage fistulotomy, 13 had a seton and staged fistulotomy. Follow-up data revealed that two fistulae recurred. The median number of procedures in this group was 1 (range 1-3). There was a significant difference in the inpatient stay depending of Park's classification (p = 0.001). In the Crohn's group, three patients with an inter-sphincteric tract underwent a single-stage fistulotomy, two patients with a trans-sphincteric tract had single-stage fistulotomy, and five required a loose seton and staged fistulotomy. Eight patients had multiple fistulae which required long-term setons. Four patients from this group eventually required proctectomy. In the Crohn's group, there was a significantly increased complexity of surgery and higher recurrence. This was reflected in an increased inpatient length of stay and a greater reliance on imaging (p = 0.001). The median number of procedures in this group was 3 (range 1-5). DISCUSSION: The majority of cryptoglandular fistula-in-ano were treated by primary fistulotomy or staged fistulotomy with a loose seton. This was associated with a low recurrence rate and low rates of faecal incontinence. There was a low reliance on imaging techniques in this group. However, we would urge caution when dealing with fistula-in-ano related to Crohn's disease. In this group of patients, the fistulae tended to be more complex and require additional imaging and multiple procedures. 相似文献
10.
Hye Kyung Chang 《Journal of pediatric surgery》2010,45(9):1832-1836