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.	中华中医药学会肛肠分会. 痔、肛瘘、肛裂、直肠脱垂的诊断标准 (试行草案). 中国肛肠病杂志, 2004, 24(4): 42-43.
2.	谭道祥. 复杂性肛瘘的诊疗体会. 中华中医药学会肛肠分会 2015 年学术年会暨流行病学研讨会, 2015: 922-924.
3.	冯静娟, 向锋, 程健, 等. 括约肌间瘘管结扎术结合脱细胞异体真皮基质填塞治疗经括约肌肛瘘的疗效分析. 中国现代医学杂志, 2018, 28(31): 78-81.
4.	张祎, 宫爱民. 经括约肌间瘘管结扎术治疗前位肛瘘疗效观察. 大连医科大学学报, 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.	陈红锦, 谷云飞, 孙桂东, 等. 经括约肌间瘘管结扎术治疗复杂性肛瘘. 中华胃肠外科杂志, 2014, 17(12): 1190-1193.
7.	赵丹丹, 李春雨. LIFT-plug 术式治疗经括约肌型肛瘘的疗效及安全性. 中国现代普通外科进展, 2017, 20(5): 386-388.
8.	王志刚, 乔运余, 张勇. 经括约肌间瘘管结扎术在低位肛瘘治疗中的应用. 实用医学杂志, 2015, 31(4): 628-630.
9.	胡云龙, 马木提江·阿巴拜克热, 艾尔哈提·胡赛音, 等. 脱细胞异体真皮基质填塞术治疗高位肛瘘的临床疗效. 医学研究杂志, 2016, 45(2): 75-78, 142.
10.	陈哲, 郑毅, 王振军, 等. 经括约肌间瘘管结扎术治疗高位单纯性肛瘘的临床疗效. 中华消化外科杂志, 2013, 12(7): 512-515.
11.	曾宪东, 张勇. 肛瘘的外科治疗. 中华胃肠外科杂志, 2014, 17(12): 1164-1166.
12.	董晓妮, 唐迎春. 吻合器痔上黏膜环切钉合术与超声引导下痔动脉结扎术治疗Ⅲ度混合痔术后肛管直肠压力的比较研究. 中华胃肠外科杂志, 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, 王振军, 郑毅, 等. 改良括约肌间瘘管结扎术治疗经括约肌型肛瘘. 中华胃肠外科杂志, 2012, 15(12): 1232-1235.
16.	于洪顺, 王敏, 段宏岩, 等. 医用生物蛋白胶治疗高位复杂性肛瘘. 中华胃肠外科杂志, 2009, 12(5): 539.
17.	韩加刚, 王振军, 赵宝成, 等. 脱细胞异体真皮基质治疗肛瘘的愈合机制研究. 中华胃肠外科杂志, 2011, 14(12): 964-967.
18.	丁曙晴. 重视肛门良性疾病手术治疗中的功能保护. 中华胃肠外科杂志, 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.	郑毅, 王振军, 杨新庆, 等. 改良括约肌间瘘管结扎术治疗慢性肛瘘的随机对照多中心临床观察. 中华医学杂志, 2015, 95(42): 3454-3457.
21.	潘春来, 黄大年, 袁和学. 改良经括约肌间瘘管结扎术治疗肛瘘的临床疗效分析. 中华胃肠外科杂志, 2015, 18(12): 1268-1270.
22.	邵万金. 括约肌间瘘管结扎术治疗肛瘘的过去、现在和将来. 中华胃肠外科杂志, 2015, 18(12): 1200-1202.
23.	鲜振宇, 林宏城, 谢尚奎, 等. 小切口改道挂线术一次治愈高位蹄形肛瘘的效果. 广东医学, 2014, 35(15): 2343-2344.
24.	王智凤, 柯美云, 孙晓红, 等. 功能性便秘患者肛门直肠动力学和感觉功能测定及其临床意义. 中华消化杂志, 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, 丁义江, 丁曙晴, 等. 便秘患者生存质量自评量表 PAC-QOL 中文版的信度、效度及反应度. 世界华人消化杂志, 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. 中华中医药学会肛肠分会. 痔、肛瘘、肛裂、直肠脱垂的诊断标准 (试行草案). 中国肛肠病杂志, 2004, 24(4): 42-43.
2. 谭道祥. 复杂性肛瘘的诊疗体会. 中华中医药学会肛肠分会 2015 年学术年会暨流行病学研讨会, 2015: 922-924.
3. 冯静娟, 向锋, 程健, 等. 括约肌间瘘管结扎术结合脱细胞异体真皮基质填塞治疗经括约肌肛瘘的疗效分析. 中国现代医学杂志, 2018, 28(31): 78-81.
4. 张祎, 宫爱民. 经括约肌间瘘管结扎术治疗前位肛瘘疗效观察. 大连医科大学学报, 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. 陈红锦, 谷云飞, 孙桂东, 等. 经括约肌间瘘管结扎术治疗复杂性肛瘘. 中华胃肠外科杂志, 2014, 17(12): 1190-1193.
7. 赵丹丹, 李春雨. LIFT-plug 术式治疗经括约肌型肛瘘的疗效及安全性. 中国现代普通外科进展, 2017, 20(5): 386-388.
8. 王志刚, 乔运余, 张勇. 经括约肌间瘘管结扎术在低位肛瘘治疗中的应用. 实用医学杂志, 2015, 31(4): 628-630.
9. 胡云龙, 马木提江·阿巴拜克热, 艾尔哈提·胡赛音, 等. 脱细胞异体真皮基质填塞术治疗高位肛瘘的临床疗效. 医学研究杂志, 2016, 45(2): 75-78, 142.
10. 陈哲, 郑毅, 王振军, 等. 经括约肌间瘘管结扎术治疗高位单纯性肛瘘的临床疗效. 中华消化外科杂志, 2013, 12(7): 512-515.
11. 曾宪东, 张勇. 肛瘘的外科治疗. 中华胃肠外科杂志, 2014, 17(12): 1164-1166.
12. 董晓妮, 唐迎春. 吻合器痔上黏膜环切钉合术与超声引导下痔动脉结扎术治疗Ⅲ度混合痔术后肛管直肠压力的比较研究. 中华胃肠外科杂志, 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, 王振军, 郑毅, 等. 改良括约肌间瘘管结扎术治疗经括约肌型肛瘘. 中华胃肠外科杂志, 2012, 15(12): 1232-1235.
16. 于洪顺, 王敏, 段宏岩, 等. 医用生物蛋白胶治疗高位复杂性肛瘘. 中华胃肠外科杂志, 2009, 12(5): 539.
17. 韩加刚, 王振军, 赵宝成, 等. 脱细胞异体真皮基质治疗肛瘘的愈合机制研究. 中华胃肠外科杂志, 2011, 14(12): 964-967.
18. 丁曙晴. 重视肛门良性疾病手术治疗中的功能保护. 中华胃肠外科杂志, 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. 郑毅, 王振军, 杨新庆, 等. 改良括约肌间瘘管结扎术治疗慢性肛瘘的随机对照多中心临床观察. 中华医学杂志, 2015, 95(42): 3454-3457.
21. 潘春来, 黄大年, 袁和学. 改良经括约肌间瘘管结扎术治疗肛瘘的临床疗效分析. 中华胃肠外科杂志, 2015, 18(12): 1268-1270.
22. 邵万金. 括约肌间瘘管结扎术治疗肛瘘的过去、现在和将来. 中华胃肠外科杂志, 2015, 18(12): 1200-1202.
23. 鲜振宇, 林宏城, 谢尚奎, 等. 小切口改道挂线术一次治愈高位蹄形肛瘘的效果. 广东医学, 2014, 35(15): 2343-2344.
24. 王智凤, 柯美云, 孙晓红, 等. 功能性便秘患者肛门直肠动力学和感觉功能测定及其临床意义. 中华消化杂志, 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, 丁义江, 丁曙晴, 等. 便秘患者生存质量自评量表 PAC-QOL 中文版的信度、效度及反应度. 世界华人消化杂志, 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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