目的 观察医用伤口修复液对肛瘘患者术后创面修复的临床疗效。方法 将78例行手术治疗的肛瘘患者随机分为2组，试验组39例，予以医用伤口修复液纱条换药，1次/d，至创面愈合；对照组39例，予以无菌凡士林纱布换药，1次/d，至创面愈合。比较2组患者的创面渗液明显减少时间、出血情况，换药时创面疼痛评分及创面愈合时间。结果 试验组的创面疼痛评分、创面渗液明显减少时间、创面愈合时间及发生创面出血的比例均短于或低于对照组，其差异均具有统计学意义（P＜0.05）。所有患者均未发生不良反应。结论 医用伤口修复液对肛瘘患者术后创面修复具有较好的临床疗效。
ObjectiveTo analyze the effect of anal fistula clip (AFC) in the treatment of anal fistula, and to evaluate its safety. MethodsA historical cohort study method was conducted. Eighty-three patients with glandular transsphincteric anal fistula in the Xuzhou Central Hospital from September 2018 to May 2021 were collected, of which 42 patients underwent the AFC treatment (AFC group), 41 patients underwent the endorectal advancement flap (ERAF) treatment (ERAF group). The operation time, intraoperative blood loss, visual analogue scale (VAS) score of anus pain on postoperative day 1, 3, and 7, wound healing time, Wexner incontinence score of anal function on postoperative month 6, and clinical efficacy (healing and failure) were compared between the two groups. ResultsThe operation was successfully completed in both groups. The operation time and intraoperative blood loss in the AFC group were shorter or less than those in the ERAF group (P<0.05). No complications such as internal opening infection and bleeding occurred in the two groups. There were no statistical differences in the VAS score of postoperative anus pain at all time point between the two groups (P>0.05). The median follow-up time was 22 months. There was no statistical difference in the wound healing time between the two groups (P>0.05). The Wexner score of anal function in the AFC group was lower than that in the ERAF group (P<0.05), and there was no statistical difference between after operation and before operation (Z=–1.751, P=0.089) in the AFC group, while that in the ERAF group after operation was higher than before operation (Z=–1.859, P=0.014). The healing rate had no statistical difference between the AFC group and ERAF group (85.7% versus 77.5%, χ2=0.925, P=0.336). Conclusion From the results of this study, the AFC is safe and effective in treatment of anal fistula, with the advantages of relatively simple operation, less bleeding during operation, lighter postoperative pain, and good protection of anal function.
ObjectiveTo compare clinical efficacy of 4 kinds of surgical treatment for high transsphincter fistula. MethodsThe clinical data of 116 patients with high transsphincter fistula in Jiangsu Province Hospital of TCM from January 2012 to December 2014 were analyzed retrospectively.These patients were divided into 4 groups according to surgical treatments,including cut seton group (n=30),loose seton group (n=34),ligation of intersphincteric fistula tract group (LIFT,n=41),mucosa advancement flap group (MAF,n=11).The length of stay,incision healing time,postoperative pain score on the second day,Wexner score when healed,postoperative complications,curative status,and recurrence were observed. Results① The length of stay in the loose seton group was significantly longer than that in the LIFT group (P<0.01),cut seton group (P<0.05) or MAF group (P<0.05),but which had no differences among the other groups (P>0.05).② The incision healing time in the loose seton group was significantly longer than that in the LIFT group (P<0.01) or the MAF group (P<0.05),but which had no differences among the other groups (P>0.05).③ The postoperative pain score on the second day in the cut seton group was significantly higher than that in the other three groups (P<0.01),which in the MAF group was lower than that in the LIFT group (P<0.05),but which had no difference between the other groups (P>0.05).④The Wexner score when healed in the cut seton group was significantly higher than that in the other three groups (P<0.01),bwt which had no differences among the other groups (P>0.05).⑤ The rate of postoperative complica-tion in the LIFT group was significantly higher than that in the loose seton group (P<0.05),but which had no differences among the other groups (P>0.05).⑥ The curative rate and recurrence rate had no statistically differences among the 4 groups (P>0.05). ConclusionsCurative rate and recurrence rate in loose seton,LIFT,and MAF group are similar with cut seton group,meanwhile they could protect anal function better and relieve pain.The length of stay and the incision healing time are longer in the loose seton group.The postoperative complications in LIFT group is increased as compared with loose seton group.The postoperative pain of MAF group is slighter than that in LIFT group.Comprehensive evaluation,MAF has more advantages,but the technique is more complex.The decision should be made individually according to patients and surgeons.
Objective To systematically evaluate the efficacy and safety for video-assisted anal fistula therapy in the treatment of complex anal fistula. Methods The databases of CKNI, Wanfang, VIP, CBM, Web of Science, PubMed, Cochrane Library and Embase were retrieved from the time of database establishment to may 31 2022. The two researchers independently screened the literatures and evaluated the quality of the literatures that met the inclusion criteria according to the research purpose and quality evaluation criteria. Meta-analysis were performed with the Revman 5.4.1 software. Results A total of 11 articles and 977 patients were included. The results of meta-analysis showed that the video-assisted group were superior to the traditional incision and thread hanging operation group in improved the cure rate [RR=1.14, 95%CI (1.04, 1.24), P<0.05], accelerated wound healing [MD=–10.40, 95%CI (–13.64, –7.17), P<0.05], protected the anal function after surgery [MD=–1.32, 95%CI (–1.85, –0.79), P＜0.05], relieved postoperative 24-hour pain [MD=–1.23, 95%CI (–1.60, –0.86), P＜0.05], shorten the operative time and hospital stay [MD=–9.46, 95%CI (–17.16, –1.75), P<0.05; MD=–3.87, 95%CI (–5.90, –1.84), P<0.05], reduced intraoperative bleeding [MD=–14.24, 95%CI (–17.49, –10.99), P<0.05] and the incidence of postoperative complications [RR=0.39, 95%CI (0.27, 0.56), P<0.05], which difference were statistically significant. However, there was no significant difference in the recurrence rate of 1-year after operation [OR=0.64, 95%CI (0.33, 1.23), P>0.05]. Conclusions Video-assisted anal fistula treatment is a safe and effective sphincter preserving operation for the treatment of complex anal fistula, which is superior to the traditional incision and thread hanging operation. However, due to the limitations and publication bias of the included literature, more prospective, large sample, multi center randomized controlled trial are needed to confirm its long-term efficacy.
ObjectiveTo summarize the occurrence of anal fistula in Crohn disease (CDAF) accompanying with preoperative rectal stenosis and analyze its influencing factors. Meanwhile to explore the effect of improved anal sphincter retention virtual-hanging (hereafter this text will be abbreviated as virtual-hanging) for treatment of CDAF. MethodsThe CDAF patients admitted to the Third People’s Hospital of Bengbu from January 2019 to June 2021 were retrospectively collected, who were treated with virtual-hanging. Meanwhile the multivariable logistic regression analysis was used to identify the risk factors for accompanying with preoperative rectal stenosis and which were used to establish a decision tree model by Chi squared automatic interaction detection method. ResultsA total of 234 patients with CDAF were collected, and the incidence of accompanying with preoperative rectal stenosis was 22.2% (52/234). The multivariate logistic regression analysis found that the patients with preoperative proctitis, Montreal subtype B2, fistula located above the musculi levator ani (MLA), single fistula accompanied by branches or multiple fistulas, lymphocyte count (Lym) ≥6.03×109/L, platelet count (PLT) ≥0.61×109/L, erythrocyte sedimentation rate (ESR) ≥39.11 mm/h, C-reactive protein (CRP) ≥5.13 mg/L, and brain natriuretic peptide (BNP) ≥313.26 ng/L had higher probability of accompanying with preoperative rectal stenosis (P<0.05). For the patients with or without preoperative rectal stenosis, the CD activity index score and perianal CD activity index score, and anal resting pressure all showed decreasing trends after treatment with the virtual-hanging, and the anal maximal contraction pressure showed a increasing trend as compared to before treatment. The decision tree consisted 18 nodes and 9 terminal nodes. The gain map of the decision tree model gradually increased from 0% to 100%; The index chart maintained a high level starting from 198% and then rapidly decreased to 100%. The area under the receiver operating characteristic curve of the decision tree model was 0.852 [95%CI (0.821, 0.908)], with a sensitivity of 84.35% and a specificity of 82.33%. ConclusionsThe incidence of accompanying with preoperative rectal stenosis in patients with CDAF is relatively higher. The effect of virtual-hanging for treatment of CDAF is better. For patients with preoperative proctitis, Montreal subtype B2, fistula above the MLA, single fistula accompanied by branches or multiple fistulas, and higher Lym, PLT, ESR, CRP, and BNP, attention should be paid to their accompanying with preoperative rectal stenosis. The decision tree model based on these factors to distinguish whether accompanying with preoperative rectal stenosis is better.
ObjectiveTo observe the effect of modified ligation of intersphincteric fistula tract (LIFT) combined with acellular anal fistula repair matrix packing in the treatment of high anal fistula, and to evaluate its clinical efficacy and safety.MethodsAll 86 patients who met the diagnostic criteria of high anal fistula in Beijing Anorectal Hospital from October 2018 to August 2019 were selected and randomly divided into observation group and control group. The observation group was treated with modified LIFT combined with acellular anal fistula repair matrix tamponade, while the control group was treated with traditional low incision and high thread drawing surgery. The curative effect, wound healing time, postoperative pain score, intraoperative blood loss, postoperative complications, hospitalization time, patient satisfaction and recurrence at 6 months after operation were compared between the two groups.ResultsThe effective rate of the observation group was 92.9% (39/42), and that of the control group was 86.4% (38/44), there was no significant difference between the two groups (Z=−1.251, P=0.211). The healing time of the observation group and the control group were (24.8±8.5) days and (32.1±10.9) days, respectively, the difference was statistically significant (t=3.472, P<0.001). Compared with the control group, the observation group had less intraoperative blood loss, less postoperative pain and shorter hospital stay (P<0.05). There was no anal incontinence after operation in the two groups, and the incidence of postoperative complications such as bloody stool, anal border edema and urinary retention were lower in the observation group (11.9%) compared with the control group (31.8%), with a statistically significant difference (P<0.05). The treatment satisfaction of the observation group was 90.5%, and that of the control group was 81.8%. There was no significant difference between the two groups (Z=−1.284, P>0.05).ConclusionModified LIFT combined with acellular anal fistula repair matrix in the treatment of high anal fistula has the advantages of small trauma, quick recovery and low incidence of complications.
Objective To compare the clinical effect between alginate calcium dressing and radix yarn dressing after anal fistula surgery. Methods A survey of 128 patients with anal fistula from April to October 2008 were studied. Patients were divided into two groups using a simple random method: 64 cases in therapy group which were treated with alginate calcium dressing and 64 cases in control group which were treated with traditional radix yarn dressing. The difference of the wound recovery indexes between two groups was compared.Results With regard to age, gender, anal fistula type, the proportion of preoperative diabetes and the diameter of wound, there was no statistical significance between therapy group and control group (Pgt;0.05). The proportion of slight pain during dressing change in therapy group (45.32%, 29/64) was more than control group (25.00%, 16/64), which had statistical significance (Pgt;0.05). The incidence of skin allergy was significantly different between two groups (29.69% vs. 60.94%, P＜0.05). Also, the rotten tissue and the soakage disappears with a shorter period, which both had statistical significance 〔(8.60±2.37) d vs. (12.22±3.29) d， (16.96±5.83) d vs. (22.02±5.90) d〕， Plt;0.05.Conclusion With the shorten of inflammatory and increment stage of the wound recovery, alginate calcium dressing is an ideal material for the postoperative duration of surgery of anal fistula.