Comparison of Four Kinds of Surgical Treatment for High Transsphincter Fistula_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

 XUMin-min ,  GUYun-fei , YANGBo-lin , CHENHong-jin

Department of Anorectal Surgery, Jiangsu Province Hospital of TCM, Nanjjing 210029, Jiangsu Province, China;

Corresponding?author：

GUYun-fei, Email: guyunfei127@126.com

Keywords：

High transsphincter fistula; Cut seton; Loose seton; Ligation of intersphincteric fistula tract; Mucosal advancement flap

DOI：

10.7507/1007-9424.20160052

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Objective To compare clinical efficacy of 4 kinds of surgical treatment for high transsphincter fistula. Methods The clinical data of 116 patients with high transsphincter fistula in Jiangsu Province Hospital of TCM from January 2012 to December 2014 were analyzed retrospectively.These patients were divided into 4 groups according to surgical treatments,including cut seton group (n=30),loose seton group (n=34),ligation of intersphincteric fistula tract group (LIFT,n=41),mucosa advancement flap group (MAF,n=11).The length of stay,incision healing time,postoperative pain score on the second day,Wexner score when healed,postoperative complications,curative status,and recurrence were observed. Results ① The length of stay in the loose seton group was significantly longer than that in the LIFT group (P<0.01),cut seton group (P<0.05) or MAF group (P<0.05),but which had no differences among the other groups (P>0.05).② The incision healing time in the loose seton group was significantly longer than that in the LIFT group (P<0.01) or the MAF group (P<0.05),but which had no differences among the other groups (P>0.05).③ The postoperative pain score on the second day in the cut seton group was significantly higher than that in the other three groups (P<0.01),which in the MAF group was lower than that in the LIFT group (P<0.05),but which had no difference between the other groups (P>0.05).④The Wexner score when healed in the cut seton group was significantly higher than that in the other three groups (P<0.01),bwt which had no differences among the other groups (P>0.05).⑤ The rate of postoperative complica-tion in the LIFT group was significantly higher than that in the loose seton group (P<0.05),but which had no differences among the other groups (P>0.05).⑥ The curative rate and recurrence rate had no statistically differences among the 4 groups (P>0.05). Conclusions Curative rate and recurrence rate in loose seton,LIFT,and MAF group are similar with cut seton group,meanwhile they could protect anal function better and relieve pain.The length of stay and the incision healing time are longer in the loose seton group.The postoperative complications in LIFT group is increased as compared with loose seton group.The postoperative pain of MAF group is slighter than that in LIFT group.Comprehensive evaluation,MAF has more advantages,but the technique is more complex.The decision should be made individually according to patients and surgeons.

Citation： XUMin-min, GUYun-fei, YANGBo-lin, CHENHong-jin. Comparison of Four Kinds of Surgical Treatment for High Transsphincter Fistula. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2016, 23(2): 201-205. doi: 10.7507/1007-9424.20160052 Copy

1.	?Parks AG, Gordon PH, Hardcastle JD. A classification of fistula-in-ano. Br J Surg, 1976, 63(1):1-12.
2.	Sirany AM, Nygaard RM, Morken JJ. The ligation of the intersphinc-teric fistula tract procedure for anal fistula:a mixed bag of results. Dis Colon Rectum, 2015, 58(6):604-612.
3.	張思勝, 王思農, 王勁坤, 等. 探討掛線療法在高位肛瘺中的應用. 醫學信息, 2013, 26(10):154-155.
4.	高萬露, 汪小海. 患者疼痛評分法的術前選擇及術后疼痛評估的效果分析. 實用醫學雜志, 2013, 29(23):3892-3894.
5.	Bretagnol F, Rullier E, Laurent C, et al. Comparison of functional results and quality of life between intersphincteric resection and conventional coloanal anastomosis for low rectal cancer. Dis Colon Rectum, 2004, 47(6):832-838.
6.	中華中醫藥學會肛腸分會. 痔、肛瘺、肛裂、直腸脫垂的診斷標準(試行草案). 中國肛腸病雜志, 2004, 24(4):42-43.
7.	Tan KK, Tan IJ, Lim FS, et al. The anatomy of failures following the ligation of intersphincteric tract technique for anal fistula:a review of 93 patients over 4 years. Dis Colon Rectum, 2011, 54(11):1368-1372.
8.	Jacob TJ, Perakath B, Keighley MR. Surgical intervention forano-rectal fistula. Cochrane Database Syst Rev, 2010, 5:CD006319.
9.	Nelson R. Anorectal abscess fistula:what do we know? Surg Clin North Am, 2002, 82(6):1139-1151, v-vi.
10.	美國結直腸外科醫師協會. 2011版美國肛周膿腫和肛瘺治療指南. 中華胃腸外科雜志, 2012, 15(6):640-643.
11.	Whiteford MH, Kilkenny J 3rd, Hyman N, et al. Practice parame-tersfor the treatment of perianal abscess and fistula-in-ano (revised). Dis Colon Rectum, 2005, 48(7):1337-1342.
12.	韋平, 谷云飛. 掛線療法在高位肛瘺治療中的臨床探討. 內蒙古中醫藥, 2013, (6):79-80.
13.	曾莉. 掛線療法的治療機理. 江蘇中醫藥, 2006, 27(8):4-5.
14.	周青, 王艷花, 陳玉根. 切割掛線在高位肛瘺使用中的不足與定向掛線的提出. 結直腸肛門外科, 2011, 17(6):397-398.
15.	邵萬金. 肛瘺的掛線治療//中西醫結合大腸肛門病研究新進展. 第十屆中國中西醫結合學會大腸肛門病學術研討會論文集, 2004:188-191.
16.	谷云飛, 陳紅錦, 史仁杰, 等. 保留括約肌掛線法治療復雜性肛瘺的臨床研究. 南京中醫藥大學學報, 2007, 23(1):20-23.
17.	Rojanasakul A, Pattanaarun J, Sahakitrungruang C, et al. Total anal sphincter saving technique for fistula-in-ano; the ligation of intersphincteric fistula tract. J Med Assoc Thai, 2007, 90(3):581-586.
18.	Yassin NA, Hammond TM, Lunniss PJ, et al. Ligation of the intersphincteric fistula tract in the management of anal fistula. A systematic review. Colorectal Dis, 2013, 15(5):527-535.
19.	Noble GH. A new operation for complete laceration of the perineum designed for the purpose of eliminating danger of infection from the rectum. Trans Am Gvnewl Soc, 1902, 27:357-363.
20.	Elting AW. X. the treatment of fistula in ano:with especial reference to the whitehead operation. Ann Surg, 1912, 56(5):744-752.
21.	Laird DR. Procedures used in treatment of complicated fistulas. Am J Surg, 1948, 76(6):701-708.
22.	Soltani A, Kaiser AM. Endorectal advancement flap for cryptoglan-dular or Crohn's fistula-in-ano. Dis Colon Rectum, 2010, 53(4):486-495.
23.	龔蘇譯. 吸煙影響肛管粘膜移行皮瓣修補治療經括約肌肛瘺的手術效果. 中醫雜志, 2003, 44(增刊):87.
24.	李暢. 復雜性肛瘺術后復發的相關因素分析. 中國醫科大學, 2014.

1. ?Parks AG, Gordon PH, Hardcastle JD. A classification of fistula-in-ano. Br J Surg, 1976, 63(1):1-12.
2. Sirany AM, Nygaard RM, Morken JJ. The ligation of the intersphinc-teric fistula tract procedure for anal fistula:a mixed bag of results. Dis Colon Rectum, 2015, 58(6):604-612.
3. 張思勝, 王思農, 王勁坤, 等. 探討掛線療法在高位肛瘺中的應用. 醫學信息, 2013, 26(10):154-155.
4. 高萬露, 汪小海. 患者疼痛評分法的術前選擇及術后疼痛評估的效果分析. 實用醫學雜志, 2013, 29(23):3892-3894.
5. Bretagnol F, Rullier E, Laurent C, et al. Comparison of functional results and quality of life between intersphincteric resection and conventional coloanal anastomosis for low rectal cancer. Dis Colon Rectum, 2004, 47(6):832-838.
6. 中華中醫藥學會肛腸分會. 痔、肛瘺、肛裂、直腸脫垂的診斷標準(試行草案). 中國肛腸病雜志, 2004, 24(4):42-43.
7. Tan KK, Tan IJ, Lim FS, et al. The anatomy of failures following the ligation of intersphincteric tract technique for anal fistula:a review of 93 patients over 4 years. Dis Colon Rectum, 2011, 54(11):1368-1372.
8. Jacob TJ, Perakath B, Keighley MR. Surgical intervention forano-rectal fistula. Cochrane Database Syst Rev, 2010, 5:CD006319.
9. Nelson R. Anorectal abscess fistula:what do we know? Surg Clin North Am, 2002, 82(6):1139-1151, v-vi.
10. 美國結直腸外科醫師協會. 2011版美國肛周膿腫和肛瘺治療指南. 中華胃腸外科雜志, 2012, 15(6):640-643.
11. Whiteford MH, Kilkenny J 3rd, Hyman N, et al. Practice parame-tersfor the treatment of perianal abscess and fistula-in-ano (revised). Dis Colon Rectum, 2005, 48(7):1337-1342.
12. 韋平, 谷云飛. 掛線療法在高位肛瘺治療中的臨床探討. 內蒙古中醫藥, 2013, (6):79-80.
13. 曾莉. 掛線療法的治療機理. 江蘇中醫藥, 2006, 27(8):4-5.
14. 周青, 王艷花, 陳玉根. 切割掛線在高位肛瘺使用中的不足與定向掛線的提出. 結直腸肛門外科, 2011, 17(6):397-398.
15. 邵萬金. 肛瘺的掛線治療//中西醫結合大腸肛門病研究新進展. 第十屆中國中西醫結合學會大腸肛門病學術研討會論文集, 2004:188-191.
16. 谷云飛, 陳紅錦, 史仁杰, 等. 保留括約肌掛線法治療復雜性肛瘺的臨床研究. 南京中醫藥大學學報, 2007, 23(1):20-23.
17. Rojanasakul A, Pattanaarun J, Sahakitrungruang C, et al. Total anal sphincter saving technique for fistula-in-ano; the ligation of intersphincteric fistula tract. J Med Assoc Thai, 2007, 90(3):581-586.
18. Yassin NA, Hammond TM, Lunniss PJ, et al. Ligation of the intersphincteric fistula tract in the management of anal fistula. A systematic review. Colorectal Dis, 2013, 15(5):527-535.
19. Noble GH. A new operation for complete laceration of the perineum designed for the purpose of eliminating danger of infection from the rectum. Trans Am Gvnewl Soc, 1902, 27:357-363.
20. Elting AW. X. the treatment of fistula in ano:with especial reference to the whitehead operation. Ann Surg, 1912, 56(5):744-752.
21. Laird DR. Procedures used in treatment of complicated fistulas. Am J Surg, 1948, 76(6):701-708.
22. Soltani A, Kaiser AM. Endorectal advancement flap for cryptoglan-dular or Crohn's fistula-in-ano. Dis Colon Rectum, 2010, 53(4):486-495.
23. 龔蘇譯. 吸煙影響肛管粘膜移行皮瓣修補治療經括約肌肛瘺的手術效果. 中醫雜志, 2003, 44(增刊):87.
24. 李暢. 復雜性肛瘺術后復發的相關因素分析. 中國醫科大學, 2014.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Comparison of Four Kinds of Surgical Treatment for High Transsphincter Fistula

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