括约肌挂浮线肛瘘栓填塞治疗高位复杂性肛瘘

发布时间：2018-05-31 11:03

本文选题：括约肌上型肛瘘 + 挂浮线　；参考：《结直肠肛门外科》2016年S2期

【摘要】：目的探讨括约肌挂浮线肛瘘栓填塞技术在治疗高位复杂性肛瘘手术中的应用。方法共治疗10例患者。一期切开括约肌外侧瘘管,保留穿过括约肌的部分瘘管,清除瘘管内坏死组织,挂浮线,二期2至4周后去浮线,切除内口处粘膜组织,将肛瘘栓修剪后由内口拉入瘘管,内口处用2-0可吸收线缝合固定于内括约肌并用粘膜覆盖,远端缝合固定于外括约肌。结果 5例治愈,术后无肛瘘栓脱落,无伤口感染,肛门功能良好;5例复发,行肛瘘挂线治疗。结论分期括约肌挂浮线肛瘘栓填塞治疗高位复杂性肛瘘对比一期手术成功率偏低,原因:(1)内口处感染几率增加;(2)瘘管管腔变大;(3)瘘管发生转折易导致引流不畅形成脓腔(4)括约肌外侧高位盲端病例填塞肛瘘栓易残留脓腔。
[Abstract]:Objective to explore the application of anal fistula plug tamponade with floating line of sphincter in the treatment of high complex anal fistula. Methods A total of 10 patients were treated. Primary incision of the lateral fistula of the sphincter, preservation of some fistula passing through the sphincter, removal of necrotic tissue in the fistula, suspension of the floating line, removal of the floating line after 2 to 4 weeks, removal of mucosal tissue at the inner mouth, trimming the anal fistula plug and pulling it into the fistula, The internal sphincter was fixed with 2-0 absorbable suture and covered with mucous membrane. The distal suture was fixed in the external sphincter. Results 5 cases were cured, no anal fistula suppository was removed, no wound infection was found, 5 cases recurred with good anal function, and 5 cases were treated with anal fistula thread. Conclusion compared with primary operation, the success rate of primary operation is lower than that of staging sphincter with floating line anal fistula plug in the treatment of high complex anal fistula. Causes: 1) the incidence of infection at the inner orifice is increased. 2) the fistula cavity becomes larger. 3) the turn of fistula leads to the obstruction of drainage and the formation of pus cavity. 4) in the case of high blind end of external sphincter, it is easy to retain pus cavity in the case of anal fistula suppository.
【作者单位】：北京市二龙路医院肛肠外科外三病区;
【分类号】：R657.16

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