肛管结扎和肌肉闭合的效果:一种新的保留肛门括约肌的手术技术。

IF 2.9 3区 医学 Q2 GASTROENTEROLOGY & HEPATOLOGY
Yoon Hyung Kang, Keehoon Hyun, Dong Ho Cho, Jong-Kyun Lee, Do-Yeon Hwang
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引用次数: 0

摘要

目的:尽管存在多种保留括约肌的技术来治疗肛瘘,但没有一种技术表现出明显的优越性。因此,本研究的目的是介绍一种用于肛管结扎和肌肉闭合(ALMC)的新型括约肌保留技术,并分析其围手术期结果。方法:回顾性分析2009年至2023年在首尔松岛医院行静脉瘘ALMC治疗的患者资料。评估患者人口统计学、术中信息和术后结果。主要观察结果为复发和创面愈合。复发定义为在初次手术完全愈合后超过12周仍存在瘘道或分泌物。临床上也对大便失禁进行了调查。结果:556例患者(男性84.0%;平均年龄(41.7±12.3岁)。其中152例(27.3%)有瘘管手术史,261例(46.9%)有胆囊上瘘。瘘管复发33例(5.9%),伤口愈合延迟97例(17.4%),大便失禁12例(2.2%)。平均随访时间10.0±16.0个月,平均复发时间13.8±10.7个月。复发组和未复发组的胃门上瘘比例相似(分别为57.6%和46.3%;p = 0.239)。延迟创面愈合组的肾盂上瘘比例略高,但差异无统计学意义(分别为56.7%比44.9%;p = 0.054)。结论:ALMC似乎是治疗肛瘘的一种安全可行的选择,提供了良好的围手术期效果,特别是当括约肌保存是至关重要的。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Efficacy of anal duct ligation and muscle closure: A novel sphincter-preserving surgical technique for fistula-in-ano.

Aim: Although various sphincter-preserving techniques exist for treating anal fistulas, none have demonstrated clear superiority. Therefore, the aim of this study was to introduce a novel sphincter-preserving technique for anal duct ligation and muscle closure (ALMC) and analyse its perioperative outcomes.

Method: The data for patients who underwent ALMC for fistula-in-ano at Seoul Song Do Hospital between 2009 and 2023 were retrospectively reviewed. Patient demographics, intraoperative information and postoperative outcomes were assessed. The main outcomes were recurrence and wound healing. Recurrence was defined as the presence of a fistula tract or discharge more than 12 weeks after the primary surgery after achieving complete healing. Faecal incontinence was also investigated clinically.

Results: Overall, 556 patients (84.0% male; mean age 41.7 ± 12.3 years) underwent ALMC. Among these, 152 (27.3%) had a history of fistula surgery and 261 (46.9%) had suprasphincteric fistulas. Fistula-in-ano recurred in 33 patients (5.9%), wound healing was delayed in 97 (17.4%) and faecal incontinence was observed in 12 (2.2%). The mean follow-up duration was 10.0 ± 16.0 months, and the average duration until recurrence was 13.8 ± 10.7 months. The proportion of suprasphincteric fistulas was similar in those who experienced recurrence and those who did not (57.6% vs. 46.3%, respectively; p = 0.239). The proportion of suprasphincteric fistulas in the delayed wound healing group was slightly higher, although the differences were not statistically significant (56.7% vs. 44.9%, respectively; p = 0.054).

Conclusion: ALMC appeared to be a safe and feasible option for treating anal fistulas, providing good perioperative outcomes, particularly when sphincter preservation was crucial.

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来源期刊
Colorectal Disease
Colorectal Disease 医学-胃肠肝病学
CiteScore
6.10
自引率
11.80%
发文量
406
审稿时长
1.5 months
期刊介绍: Diseases of the colon and rectum are common and offer a number of exciting challenges. Clinical, diagnostic and basic science research is expanding rapidly. There is increasing demand from purchasers of health care and patients for clinicians to keep abreast of the latest research and developments, and to translate these into routine practice. Technological advances in diagnosis, surgical technique, new pharmaceuticals, molecular genetics and other basic sciences have transformed many aspects of how these diseases are managed. Such progress will accelerate. Colorectal Disease offers a real benefit to subscribers and authors. It is first and foremost a vehicle for publishing original research relating to the demanding, rapidly expanding field of colorectal diseases. Essential for surgeons, pathologists, oncologists, gastroenterologists and health professionals caring for patients with a disease of the lower GI tract, Colorectal Disease furthers education and inter-professional development by including regular review articles and discussions of current controversies. Note that the journal does not usually accept paediatric surgical papers.
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