【摘要】 目的从复杂性肛瘘治疗的回顾及进展思考目前已经出现的手术和疗法中哪些可能成为今后主流或一线治疗。方法通过文献复习,以复杂性肛瘘治疗的难点和矛盾为出发点,回顾目前已广泛应用的挂线疗法,综述近年来生物疗法和保留括约肌手术的发展与不足,思考复杂性肛瘘治疗模式的转变,重点关注经括约肌间瘘管结扎术在该领域的研究进展和应用前景。结果复杂性肛瘘的治疗不再过分强调愈合或根治,而更加注重肛门功能、形态、精细感觉、生活质量等已成为共识。挂线疗法经过不断的改良和发展,是治疗复杂性肛瘘的有力手段,但仍有不少患者术后出现复发或轻-中度肛门失禁。国外近年兴起的生物疗法虽然创伤极小,但因其费用高、疗效不确定及复发率高限制了其在我国更为广泛的应用。保留括约肌手术一直维持着相当的活力和热度,尤其是在现代医学极力倡导微创治疗及生活质量的大背景之下。经括约肌间瘘管结扎术作为一项创新性新技术,其临床疗效和安全性已得到初步证实,保护肛门功能的显著优势亦得到广泛认可,且适合推广。结论经括约肌间瘘管结扎术可能将逐渐取代甚至超越瘘管切开挂线术及其衍生、改良术式,成为复杂性肛瘘的一线治疗方案。更多还原

【Abstract】 Objective To trace and review the treatment of complex anal fistula so as to consider whether current procedures and therapies might offer a better choice. Methods Through the literature collected,with the difficulties and contradictions of the treatment of complex anal fistula as the starting point,the currently widely used seton management,the development and deficiency of biological therapy and sphincter preserving surgery,and the change of treatment model of complex anal fistula were reviewed. The research progress and application prospect of intersphincteric fistula ligation was focus attented. Results The treatment of complex anal fistula would be not too much emphasis of healing or radical cure,and more attention to the anus function,shape,fine feeling,and quality of life,has become a consensus. The seton management remained an useful therapy for the treatment of complicated anal fistula through continuous improvement and development,in despite of it has postoperative relapse or mild to moderate anal incontinence. Biotherapy relied on its minimal invasion rising in recent years especially at abroad,but it is limited wider application in China because of its high cost,unstable efficacy,and high recurrence rate. Sphincter-preserving operation always attracts attentions particularly under the background of invasive treatment. It has been already established about efficacy and security of the ligation of intersphincteric fistula tract as a novel procedure,which possessed an excellent advantage for protecting anal continence.Conclusion The ligation of intersphincteric fistula tract is a promising procedure,which tends to be superior than fistulotomy and seton management,may become a first-line treatment of complex anal fistula.更多还原