Observation on the changes of anal function in the treatment of transjottic anal fistula by LIFT technique and anal fistula incision

doi:10.3877/cma.j.issn.2095-3224.2018.01.010

Abstract

Abstract:

Objective

To observe the effect of LIFT surgery and anal fistula incision on the metastatic anal fistula in the near-long anal function.

Methods

A total of 120 patients with sphincter anal fistula treated in our hospital from September 2015 to February 2017 were randomly divided into observation group and control group, sixty cases in each group. The control group was treated with anal fistula incision, the observation group was treated with LIFT surgery. The operation time, wound healing time, the VAS pain score at 1 d, 3 d and 7 d after operation, the total cure rate, the total incidence of postoperative complications of 1 month after operation, the recurrence rate of followed up six months, the anal function (evaluated by pelvic floor electromyography and anal rectal pressure) of before operation and 1 month and 6 months after operation were compared between the two groups.

Results

The wound healing time of the observation group was (27.44±6.12) d, which shorter than (32.71±8.35) d in the control group (t=-3.943, P=0.000). There were no significant difference in VAS pain scores between the two groups at 1 d and 3 d after operation (P>0.05). The VAS pain score of the observation group was (2.11±0.66) at the 7 th day after operation, which was lower than that of the control group (3.56±0.91) (t=-9.991, P=0.000). The healing rates of the observation group and the control group were 90.00% and 93.33%, and the recurrence rates were 13.33% and 10.00%, the difference were not significant (P>0.05). The total incidence of postoperative complications was 3.33% in the observation group, which was lower than 13.33% in control group (χ²=3.927, P=0.048). There was no significant difference between the mean time limit of MUP in the puborectal muscles, internal sphincter and external sphincter, anal canal resting pressure and anal canal maximum systolic blood pressure of 1 month and 6 months after operation were no statistically significant compared to preoperative in observation group (P>0.05), and were decreased in the control group (P<0.05). The mean time limit of MUP in the puborectal muscles, internal sphincter and external sphincter, anal canal resting pressure and anal canal maximum systolic blood pressure of 1 month and 6 months after operation in observation group were higher than those in control group.

Conclusion

The LIFT treatment of the sphincter anal fistula can reduce the operation of the sphincter injury, thereby reducing the patient′s postoperative pain, promote wound healing, reduce postoperative complications, so that patients with near-term anal function was protected.

Key words: Transthoracic fistula, Anal fistula incision, Ligation of the intersphinctericfistula tract, Anal function

Pengjun Jiang, Guozhen Ma, Hengliang Liu, Yingsheng Gong, Wen Peng. Observation on the changes of anal function in the treatment of transjottic anal fistula by LIFT technique and anal fistula incision[J]. Chinese Journal of Colorectal Diseases(Electronic Edition), 2018, 07(01): 47-51.

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References 18

[1]	田颖，张忠涛，安少雄, 等.括约肌间瘘管结扎术在单纯肛瘘治疗中的临床疗效观察 [J]. 中华胃肠外科杂志, 2015, 18(12): 1211-1214.
[2]	邵万金.括约肌间瘘管结扎术治疗肛瘘的过去、现在和将来 [J]. 中华胃肠外科杂志, 2015, 18(12): 1200-1202.
[3]	Yassin NA, Hammond TM, Lunniss PJ, et al. Ligation of the intersphincteric fistula tract in the management of anal fistula. A systematic review [J]. Colorectal Dis, 2013, 15(5): 527-535.
[4]	张永刚，张茂香，唐淑敏, 等.括约肌间瘘管结扎术与切开挂线术治疗复杂性肛瘘的临床疗效比较 [J]. 中华普通外科杂志, 2012, 27(11): 940-941.
[5]	芦亚峰，杨巍，陆宏, 等.对口切开皮桥保留术治疗低位经括约肌肛瘘的临床研究 [J]. 中国综合临床, 2015, 31(9): 769-772.
[6]	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 [J]. 中华胃肠外科杂志, 2012, 15(12): 1232-1235.
[7]	武文静，杨关根，杜忠举, 等.改良经括约肌间瘘管结扎术治疗单纯性经括约肌型肛瘘的临床疗效 [J]. 中华胃肠外科杂志, 2014, 17(12): 1194-1197.
[8]	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 [J]. 中华消化外科杂志, 2013, 12(7): 512-515.
[9]	Schulze B, Ho YH. Management of complex anorectal fistulas with seton drainage plus partial fistulotomy and subsequent ligation of intersphincteric fistula tract (LIFT) [J]. Tech Coloproctol, 2015, 19(2): 89-95.
[10]	Zirak-Schmidt S, Perdawood SK. Management of anal fistula by ligation of the intersphincteric fistula tract - a systematic review [J]. Dan Med J, 2014, 61(12): 4977-4981.
[11]	Romaniszyn M, Walega PJ, Nowak W. Efficacy of lift (ligation of intersphincteric fistula tract) for complex and recurrent anal fistulas--a single-center experience and a review of the literature [J]. Pol Przegl Chir, 2014, 86(11): 532-536.
[12]	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 [J]. 中华医学杂志, 2015, 95(42): 3454-3457.
[13]	陈豪，杨柏霖，杨光, 等.经括约肌间瘘管结扎术治疗经括约肌肛瘘的多中心前瞻性研究 [J]. 中华消化外科杂志, 2016, 15(8): 825-829.
[14]	Patton V, Chen CM, Lubowski D, et al. Long-term results of the cutting seton for high anal fistula [J]. ANZ J Surg, 2015, 85(10): 720-727.
[15]	Amato A, Bottini C, De Nardi P, et al. Evaluation and management of perianal abscess and anal fistula: a consensus statement developed by the Italian Society of Colorectal Surgery (SICCR) [J]. Tech Coloproctol, 2015, 19(10): 595-606.
[16]	Ye F, Tang C, Wang D, et al. Early experience with the modificated approach of ligation of the intersphincteric fistula tract for high transsphincteric fistula [J]. World J Surg, 2015, 39(4): 1059-1065.
[17]	王志刚，乔运余，张勇, 等.经括约肌间瘘管结扎术在低位肛瘘治疗中的应用 [J]. 实用医学杂志, 2015, 31(4): 628-630.
[18]	Han JG, Yi BQ, Wang ZJ, et al. Ligation of the intersphincteric fistula tract plus a bioprosthetic anal fistula plug (LIFT-Plug): a new technique for fistula-in-ano [J]. Colorectal Dis, 2013, 15(5): 582-586.

组别	手术时间（min）	创面愈合时间（d）	术后VAS疼痛评分（分）
组别	手术时间（min）	创面愈合时间（d）	术后第1 d	术后第3 d	术后第7 d
观察组（n=60）	52.51±12.32	27.44±6.12	1.43±0.48	4.02±1.00	2.11±0.66
对照组（n=60）	48.98±11.88	32.71±8.35	1.54±0.55	4.36±0.89	3.56±0.91
t值	1.598	-3.943	-1.167	-1.967	-9.991
P值	0.113	0.000	0.246	0.052	0.000

组别	手术时间（min）	创面愈合时间（d）	术后VAS疼痛评分（分）
组别	手术时间（min）	创面愈合时间（d）	术后第1 d	术后第3 d	术后第7 d
观察组（n=60）	52.51±12.32	27.44±6.12	1.43±0.48	4.02±1.00	2.11±0.66
对照组（n=60）	48.98±11.88	32.71±8.35	1.54±0.55	4.36±0.89	3.56±0.91
t值	1.598	-3.943	-1.167	-1.967	-9.991
P值	0.113	0.000	0.246	0.052	0.000

组别	治愈数	?	术后并发症			?	复发数
组别	治愈数	顽固性肛门疼痛	愈合延迟	异物感	肛门失禁	总数	复发数
观察组（n=60）	54（90.00）	1（1.67）	0（0）	1（1.67）	0（0）	2（3.33）	8（13.33）
对照组（n=60）	56（93.33）	1（1.67）	2（3.33）	1（1.67）	4（6.67）	8（13.33）	6（10.00）
χ²值	0.436	0.508^*	0.508^*	0.508^*	2.328^*	3.927	0.324
P值	0.509	0.476	0.476	0.476	0.127	0.048	0.570

组别	治愈数	?	术后并发症			?	复发数
组别	治愈数	顽固性肛门疼痛	愈合延迟	异物感	肛门失禁	总数	复发数
观察组（n=60）	54（90.00）	1（1.67）	0（0）	1（1.67）	0（0）	2（3.33）	8（13.33）
对照组（n=60）	56（93.33）	1（1.67）	2（3.33）	1（1.67）	4（6.67）	8（13.33）	6（10.00）
χ²值	0.436	0.508^*	0.508^*	0.508^*	2.328^*	3.927	0.324
P值	0.509	0.476	0.476	0.476	0.127	0.048	0.570

组别	时间	MUP平均时限（ms）			肛门直肠压力（mmHg）
组别	时间	耻骨直肠肌	内括约肌	外括约肌	肛管静息压	肛管最大收缩压
观察组（n=60）	术前	7.04±1.89	7.72±2.00	6.59±2.01	47.19±5.77	184.99±22.14
	术后1个月	6.81±1.68^#	7.49±1.89^#	6.27±1.87^#	45.43±6.04^#	180.73±23.41^#
	术后6个月	6.99±1.58^#	7.63±1.77^#	6.41±1.95^#	44.11±6.71^#	184.34±23.88^#
对照组（n=60）	术前	7.10±1.95	7.69±1.88	6.75±1.94	48.00±6.07	187.22±20.76
	术后1个月	6.06±1.59^*	6.78±1.53^*	5.52±1.69^*	42.63±7.01^*	171.44±21.34^*
	术后6个月	6.21±1.44^*	6.90±1.73^*	5.72±1.77^*	41.00±7.13^*	171.50±22.63^*

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