文档介绍：肛瘘诊治进展
--从《06版肛瘘临床诊治指南》再谈肛瘘的治疗
★ 2002年中华医学会外科学分会肛肠外科学组根据国内外医学的最新进展和广大医务工作者在临床应用后提出的意见和建议,制订了《肛瘘诊治标准》;
★ 2006年7月提出《肛瘘临床诊治指南》:由中华医学会外科学分会结直肠肛门外科学组、中华中医药学会肛肠分会、中国中西医结合学会结直肠肛门病专业委员会共同制订;
☆2006年7月《肛瘘临床诊治指南》;
☆美国结直肠外科医生协会(ASCRS: American Society of Colo-Rectal Surgeon ):Guideline 指南;
治疗原则(06版):
1) 手术治疗是肛瘘的主要手段,基本原则是:去除病灶,通畅引流,尽可能减少肛管括约肌损伤,保护肛门功能;
2)由于肛瘘的复杂性和一些特殊的病理背景,肛瘘术后有一定的复发率;
手术是治疗肛瘘的惟一可靠的办法,但手术成功率报道不一,尤其是高位肛瘘,首次手术复发率高达50%,再次手术失败率仍高达10%以上;
治疗原则(续,06版)
3)鉴于高位复杂性肛瘘的特殊病理和生理环境及肛门功能的重要性,“带瘘生存,亦可作为一个原则加以选择,不应为盲目追求手术根治而忽视其可能带来的严重并发症;
4)中药治疗仅限于患者恢复期的调整和暂不适合手术者。
The goals in the treatment of fistula-in-ano (ASCRS):
To eliminate the septic foci and any associated epithelialized tracks;
2) to do so with the least amount of functional derangement.
3)There is no single technique appropriate for the treatment of all fistulas-in-ano and, therefore, treatment must be directed by the surgeon’s experience and judgment.
手术方式:
1)肛瘘切开(除)术:适用于单纯性肛瘘
肛瘘切开术较好,肛瘘切除术创面较大,愈合时间相对较长,可发生肛门失禁。
Treatment of a Simple Fistula-in-Ano:
1. Simple anal fistulas may be treated by fistulotomy.
Fistulotomy is preferable to fistulectomy.
Despite similar recurrence rates, the latter results in larger wounds with a longer healing time and higher rates of incontinence.
The recurrence rate for fistulotomy is generally between 2 and 9 percent with a functional impairment generally between 0 and 17 percent. Any functional derangement will tend to improve for up to two years after surgery.
One randomized, controlled trial reported faster healing and better preservation of anal squeeze pressures when anal fistulotomy wounds were pared with simply laid open.
2. Simple anal fistulas may be treated with track
debridement and fibrin glue injection.
Fibrin glue is an easy and repeatable treatment for fistula in- ano with relatively few side effects and little to no risk of fecal incontinence. essful healing rates
from 60 to 70 percent can be achieved. Risk factors
for failure