A prospectively clinical comparative study of ligation of intersphincteric fistula tract in treatment of high simple anal fistula_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

LIU Yang ,  LU Ming

Department of Anorectal Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi 830054, P. R. China;

Corresponding?author：

LU Ming, Email: luming123luming@163.com

Keywords：

high simple anal fistula; ligation of intersphincteric fistula tract; prospective analysis; anal-rectal pressure measurement

DOI：

10.7507/1007-9424.201907036

Video：

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Objective To explore the clinical efficacy and safety of ligation of intersphincteric fistula tract in the treatment of high simple anal fistula.Methods A prospective collection of 72 patients diagnosed with high simple anal fistula, who admitted to the department of the author’s hospital between March 2015 and December 2017 was performed, and then the patients were divided into two groups according to the random number table method combined with the patients’ wishes: the ligation of intersphincteric fistula tract group (experimental group, 32 cases) and the low incision and high hanging group (control group, 40 cases). Comparison of indexes on the operative effect and physiological function of the sphincter in six months after operation was performed.Results Compared with the control group, the patients in the experimental group had short postoperative pain duration, short postoperative wound healing time, high cure rate, low recurrence rate, low initial sensory threshold, high anal resting pressure, and long anal high pressure band length, with statistically significant differences (P<0.05). However, there was no statistically significant difference between the two groups in the operation time, anal maximal contractive pressure, and rectal resting pressure (P>0.05). The results suggested that the physiological function of anus in the experimental group recovered well.Conclusion The ligation of intersphincteric fistula tract is a safe and reliable method in the treatment of high simple anal fistula, which can be widely used in the clinic.

Citation： LIU Yang, LU Ming. A prospectively clinical comparative study of ligation of intersphincteric fistula tract in treatment of high simple anal fistula. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2020, 27(2): 143-146. doi: 10.7507/1007-9424.201907036 Copy

1.	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.
2.	譚道祥. 復雜性肛瘺的診療體會. 中華中醫藥學會肛腸分會 2015 年學術年會暨流行病學研討會, 2015: 922-924.
3.	馮靜娟, 向鋒, 程健, 等. 括約肌間瘺管結扎術結合脫細胞異體真皮基質填塞治療經括約肌肛瘺的療效分析. 中國現代醫學雜志, 2018, 28(31): 78-81.
4.	張祎, 宮愛民. 經括約肌間瘺管結扎術治療前位肛瘺療效觀察. 大連醫科大學學報, 2018, 40(3): 234-237, 246.
5.	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.
6.	陳紅錦, 谷云飛, 孫桂東, 等. 經括約肌間瘺管結扎術治療復雜性肛瘺. 中華胃腸外科雜志, 2014, 17(12): 1190-1193.
7.	趙丹丹, 李春雨. LIFT-plug 術式治療經括約肌型肛瘺的療效及安全性. 中國現代普通外科進展, 2017, 20(5): 386-388.
8.	王志剛, 喬運余, 張勇. 經括約肌間瘺管結扎術在低位肛瘺治療中的應用. 實用醫學雜志, 2015, 31(4): 628-630.
9.	胡云龍, 馬木提江·阿巴拜克熱, 艾爾哈提·胡賽音, 等. 脫細胞異體真皮基質填塞術治療高位肛瘺的臨床療效. 醫學研究雜志, 2016, 45(2): 75-78, 142.
10.	陳哲, 鄭毅, 王振軍, 等. 經括約肌間瘺管結扎術治療高位單純性肛瘺的臨床療效. 中華消化外科雜志, 2013, 12(7): 512-515.
11.	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.
12.	董曉妮, 唐迎春. 吻合器痔上黏膜環切釘合術與超聲引導下痔動脈結扎術治療Ⅲ度混合痔術后肛管直腸壓力的比較研究. 中華胃腸外科雜志, 2013, 16(12): 1183-1186.
13.	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.
14.	Bleier JI, Moloo H, Goldberg SM. Ligation of the intersphincteric fistula tract: an effective new technique for complex fistulas. Dis Colon Rectum, 2010, 53(1): 43-46.
15.	崔金杰, 王振軍, 鄭毅, 等. 改良括約肌間瘺管結扎術治療經括約肌型肛瘺. 中華胃腸外科雜志, 2012, 15(12): 1232-1235.
16.	于洪順, 王敏, 段宏巖, 等. 醫用生物蛋白膠治療高位復雜性肛瘺. 中華胃腸外科雜志, 2009, 12(5): 539.
17.	韓加剛, 王振軍, 趙寶成, 等. 脫細胞異體真皮基質治療肛瘺的愈合機制研究. 中華胃腸外科雜志, 2011, 14(12): 964-967.
18.	丁曙晴. 重視肛門良性疾病手術治療中的功能保護. 中華胃腸外科雜志, 2014, 17(12): 1167-1169.
19.	van Onkelen RS, Gosselink MP, Schouten WR. Ligation of the intersphincteric fistula tract in low transsphincteric fistulae: a new technique to avoid fistulotomy. Colorectal Dis, 2013, 15(5): 587-591.
20.	鄭毅, 王振軍, 楊新慶, 等. 改良括約肌間瘺管結扎術治療慢性肛瘺的隨機對照多中心臨床觀察. 中華醫學雜志, 2015, 95(42): 3454-3457.
21.	潘春來, 黃大年, 袁和學. 改良經括約肌間瘺管結扎術治療肛瘺的臨床療效分析. 中華胃腸外科雜志, 2015, 18(12): 1268-1270.
22.	邵萬金. 括約肌間瘺管結扎術治療肛瘺的過去、現在和將來. 中華胃腸外科雜志, 2015, 18(12): 1200-1202.
23.	鮮振宇, 林宏城, 謝尚奎, 等. 小切口改道掛線術一次治愈高位蹄形肛瘺的效果. 廣東醫學, 2014, 35(15): 2343-2344.
24.	王智鳳, 柯美云, 孫曉紅, 等. 功能性便秘患者肛門直腸動力學和感覺功能測定及其臨床意義. 中華消化雜志, 2004, 24(9): 526-529.
25.	Meurette G, Blanchard C, Duchalais-Dassonneville E, et al. Sacral nerve stimulation enhances epithelial barrier of the rectum: results from a porcine model. Neurogastroenterol Motil, 2012, 24(3): 267-273.
26.	金洵, 丁義江, 丁曙晴, 等. 便秘患者生存質量自評量表 PAC-QOL 中文版的信度、效度及反應度. 世界華人消化雜志, 2011, 19(2): 209-213.
27.	Emmanuel A. Current management strategies and therapeutic targets in chronic constipation. Therap Adv Gastroenterol, 2011, 4(1): 37-48.

1. 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.
2. 譚道祥. 復雜性肛瘺的診療體會. 中華中醫藥學會肛腸分會 2015 年學術年會暨流行病學研討會, 2015: 922-924.
3. 馮靜娟, 向鋒, 程健, 等. 括約肌間瘺管結扎術結合脫細胞異體真皮基質填塞治療經括約肌肛瘺的療效分析. 中國現代醫學雜志, 2018, 28(31): 78-81.
4. 張祎, 宮愛民. 經括約肌間瘺管結扎術治療前位肛瘺療效觀察. 大連醫科大學學報, 2018, 40(3): 234-237, 246.
5. 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.
6. 陳紅錦, 谷云飛, 孫桂東, 等. 經括約肌間瘺管結扎術治療復雜性肛瘺. 中華胃腸外科雜志, 2014, 17(12): 1190-1193.
7. 趙丹丹, 李春雨. LIFT-plug 術式治療經括約肌型肛瘺的療效及安全性. 中國現代普通外科進展, 2017, 20(5): 386-388.
8. 王志剛, 喬運余, 張勇. 經括約肌間瘺管結扎術在低位肛瘺治療中的應用. 實用醫學雜志, 2015, 31(4): 628-630.
9. 胡云龍, 馬木提江·阿巴拜克熱, 艾爾哈提·胡賽音, 等. 脫細胞異體真皮基質填塞術治療高位肛瘺的臨床療效. 醫學研究雜志, 2016, 45(2): 75-78, 142.
10. 陳哲, 鄭毅, 王振軍, 等. 經括約肌間瘺管結扎術治療高位單純性肛瘺的臨床療效. 中華消化外科雜志, 2013, 12(7): 512-515.
11. 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.
12. 董曉妮, 唐迎春. 吻合器痔上黏膜環切釘合術與超聲引導下痔動脈結扎術治療Ⅲ度混合痔術后肛管直腸壓力的比較研究. 中華胃腸外科雜志, 2013, 16(12): 1183-1186.
13. 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.
14. Bleier JI, Moloo H, Goldberg SM. Ligation of the intersphincteric fistula tract: an effective new technique for complex fistulas. Dis Colon Rectum, 2010, 53(1): 43-46.
15. 崔金杰, 王振軍, 鄭毅, 等. 改良括約肌間瘺管結扎術治療經括約肌型肛瘺. 中華胃腸外科雜志, 2012, 15(12): 1232-1235.
16. 于洪順, 王敏, 段宏巖, 等. 醫用生物蛋白膠治療高位復雜性肛瘺. 中華胃腸外科雜志, 2009, 12(5): 539.
17. 韓加剛, 王振軍, 趙寶成, 等. 脫細胞異體真皮基質治療肛瘺的愈合機制研究. 中華胃腸外科雜志, 2011, 14(12): 964-967.
18. 丁曙晴. 重視肛門良性疾病手術治療中的功能保護. 中華胃腸外科雜志, 2014, 17(12): 1167-1169.
19. van Onkelen RS, Gosselink MP, Schouten WR. Ligation of the intersphincteric fistula tract in low transsphincteric fistulae: a new technique to avoid fistulotomy. Colorectal Dis, 2013, 15(5): 587-591.
20. 鄭毅, 王振軍, 楊新慶, 等. 改良括約肌間瘺管結扎術治療慢性肛瘺的隨機對照多中心臨床觀察. 中華醫學雜志, 2015, 95(42): 3454-3457.
21. 潘春來, 黃大年, 袁和學. 改良經括約肌間瘺管結扎術治療肛瘺的臨床療效分析. 中華胃腸外科雜志, 2015, 18(12): 1268-1270.
22. 邵萬金. 括約肌間瘺管結扎術治療肛瘺的過去、現在和將來. 中華胃腸外科雜志, 2015, 18(12): 1200-1202.
23. 鮮振宇, 林宏城, 謝尚奎, 等. 小切口改道掛線術一次治愈高位蹄形肛瘺的效果. 廣東醫學, 2014, 35(15): 2343-2344.
24. 王智鳳, 柯美云, 孫曉紅, 等. 功能性便秘患者肛門直腸動力學和感覺功能測定及其臨床意義. 中華消化雜志, 2004, 24(9): 526-529.
25. Meurette G, Blanchard C, Duchalais-Dassonneville E, et al. Sacral nerve stimulation enhances epithelial barrier of the rectum: results from a porcine model. Neurogastroenterol Motil, 2012, 24(3): 267-273.
26. 金洵, 丁義江, 丁曙晴, 等. 便秘患者生存質量自評量表 PAC-QOL 中文版的信度、效度及反應度. 世界華人消化雜志, 2011, 19(2): 209-213.
27. Emmanuel A. Current management strategies and therapeutic targets in chronic constipation. Therap Adv Gastroenterol, 2011, 4(1): 37-48.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

A prospectively clinical comparative study of ligation of intersphincteric fistula tract in treatment of high simple anal fistula

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