一種新型保留括約肌術式：激光瘺管閉合術治療復雜性肛瘺_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

楊勇 , 張正國 ,  楊光

徐州市中心醫院肛腸科（江蘇徐州 221009）;

Corresponding?author：

楊光, Email: 362939833@qq.com

Keywords：

激光瘺管閉合術; 保留括約肌術式; 復雜性肛瘺

DOI：

10.7507/1007-9424.201704108

Video：

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目的初步探討激光瘺管閉合術治療復雜性肛瘺的臨床療效。方法回顧性分析 2016 年 8 月至 2017 年 3 月期間筆者所在醫院科室行激光瘺管閉合術治療的復雜性肛瘺 5 例患者的臨床資料。結果 5 例患者術后一期愈合 4 例；另1 例于術后 5 d 失敗，于局麻下自括約肌間溝切開內口部分，外口至括約肌間瘺管掛皮筋引流，15 d 后拆除引流皮筋，22 d 后愈合。5 例患者平均手術時間為 10 min，術中均無明顯出血和括約肌損傷。肛門疼痛視覺模擬評分術后第 3 天平均為 3.8 分，第 5 天平均為 1.6 分。術后平均住院時間為 8.5 d。術后平均隨訪 8 個月（3～11 個月）無復發，無并發癥及肛門失禁發生。結論從本研究的數據初步得出，激光瘺管閉合術治療復雜性肛瘺安全、有效，完全保留了括約肌，術后疼痛輕，恢復快，對肛門功能保護較好。

Citation： 楊勇, 張正國, 楊光. 一種新型保留括約肌術式：激光瘺管閉合術治療復雜性肛瘺. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2017, 24(11): 1384-1386. doi: 10.7507/1007-9424.201704108 Copy

1.	任東林, 張恒. 復雜性肛瘺診治中需要注意的幾個關鍵問題. 中華胃腸外科雜志, 2015, 18(12): 1186-1192.
2.	Wilhelm A. A new technique for sphincter-preserving anal fistula repair using a novel radial emitting laser probe. Tech Coloproctol, 2011, 15(4): 445-449.
3.	Woodforde JM, Merskey H. Some relationships between subjective measures of pain. J Psychosom Res, 1972, 16(3): 173-178.
4.	Jorge JM, Wexner SD. Etiology and management of fecal incontinence. Dis Colon Rectum, 1993, 36(1): 77-97.
5.	Vogel JD, Johnson EK, Morris AM, et al. Clinical practice guideline for the management of anorectal abscess, fistula-in-ano, and rectovaginal fistula. Dis Colon Rectum, 2016, 59(12): 1117-1133.
6.	曾憲東, 張勇. 肛瘺的外科治療. 中華胃腸外科雜志, 2014, 17(12): 1164-1166.
7.	陳豪, 冷強, 金黑鷹, 等. 國內外肛瘺診療現狀的對比與啟示. 世界華人消化雜志, 2016, 24(6): 978-982.
8.	Slutzki S, Abramsohn R, Bogokowsky H. Carbon dioxide laser in the treatment of high anal fistula. Am J Surg, 1981, 141(3): 395-396.
9.	Anderson RR, Parrish JA. Selective photothermolysis: precise microsurgery by selective absorption of pulsed radiation. Science, 1983, 220(4596): 524-527.
10.	Giamundo P, Geraci M, Tibaldi L, et al. Closure of fistula-in-ano with laser—FiLaC^TM: an effective novel sphincter-saving procedure for complex disease. Colorectal Dis, 2014, 16(2): 110-115.
11.	Giamundo P, Esercizio L, Geraci M, et al. Fistula-tract Laser Closure (FiLaC^TM): long-term results and new operative strategies. Tech Coloproctol, 2015, 19(8): 449-453.
12.	Oztürk E, Gülcü B. Laser ablation of fistula tract: a sphincter-preserving method for treating fistula-in-ano. Dis Colon Rectum, 2014, 57(3): 360-364.
13.	Wilhelm A, Fiebig A, Krawczak M. Five years of experience with the FiLaC^TM laser for fistula-in-ano management: long-term follow-up from a single institution. Tech Coloproctol, 2017, 21(4): 269-276.
14.	Ommer A, Herold A, Berg E, et al. German S3 guidelines: anal abscess and fistula (second revised version). Langenbecks Arch Surg, 2017, 402(2): 191-201.
15.	楊勇, 張正國, 楊光. 激光瘺管閉合術治療肛瘺一例. 中華結直腸電子雜志, 2017, 6(3): 255-256.

1. 任東林, 張恒. 復雜性肛瘺診治中需要注意的幾個關鍵問題. 中華胃腸外科雜志, 2015, 18(12): 1186-1192.
2. Wilhelm A. A new technique for sphincter-preserving anal fistula repair using a novel radial emitting laser probe. Tech Coloproctol, 2011, 15(4): 445-449.
3. Woodforde JM, Merskey H. Some relationships between subjective measures of pain. J Psychosom Res, 1972, 16(3): 173-178.
4. Jorge JM, Wexner SD. Etiology and management of fecal incontinence. Dis Colon Rectum, 1993, 36(1): 77-97.
5. Vogel JD, Johnson EK, Morris AM, et al. Clinical practice guideline for the management of anorectal abscess, fistula-in-ano, and rectovaginal fistula. Dis Colon Rectum, 2016, 59(12): 1117-1133.
6. 曾憲東, 張勇. 肛瘺的外科治療. 中華胃腸外科雜志, 2014, 17(12): 1164-1166.
7. 陳豪, 冷強, 金黑鷹, 等. 國內外肛瘺診療現狀的對比與啟示. 世界華人消化雜志, 2016, 24(6): 978-982.
8. Slutzki S, Abramsohn R, Bogokowsky H. Carbon dioxide laser in the treatment of high anal fistula. Am J Surg, 1981, 141(3): 395-396.
9. Anderson RR, Parrish JA. Selective photothermolysis: precise microsurgery by selective absorption of pulsed radiation. Science, 1983, 220(4596): 524-527.
10. Giamundo P, Geraci M, Tibaldi L, et al. Closure of fistula-in-ano with laser—FiLaC^TM: an effective novel sphincter-saving procedure for complex disease. Colorectal Dis, 2014, 16(2): 110-115.
11. Giamundo P, Esercizio L, Geraci M, et al. Fistula-tract Laser Closure (FiLaC^TM): long-term results and new operative strategies. Tech Coloproctol, 2015, 19(8): 449-453.
12. Oztürk E, Gülcü B. Laser ablation of fistula tract: a sphincter-preserving method for treating fistula-in-ano. Dis Colon Rectum, 2014, 57(3): 360-364.
13. Wilhelm A, Fiebig A, Krawczak M. Five years of experience with the FiLaC^TM laser for fistula-in-ano management: long-term follow-up from a single institution. Tech Coloproctol, 2017, 21(4): 269-276.
14. Ommer A, Herold A, Berg E, et al. German S3 guidelines: anal abscess and fistula (second revised version). Langenbecks Arch Surg, 2017, 402(2): 191-201.
15. 楊勇, 張正國, 楊光. 激光瘺管閉合術治療肛瘺一例. 中華結直腸電子雜志, 2017, 6(3): 255-256.

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