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| 瘘管切开术的预后：一项前瞻性多中心区域性研究的结果 |
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| Outcomes After Fistulotomy: Results of a Prospective, Multicenter Regional Study |
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| Hyman N, O'Brien S, Osler T 2010/8/9 15:04:29 |
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| Dis Colon Rectum, 2010, |
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| View at Publisher |
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Purpose:
This study aimed to determine the outcomes and healing rate after fistula surgery across a broad spectrum of colorectal practices.
Methods:
A prospective, multicenter outcomes registry was created by the New England Regional Chapter of The American Society of Colon and Rectal Surgeons. All consecutive patients undergoing surgical treatment of an anal fistula by a participating surgeon from October 1, 2007 to September 30, 2008, were entered. Demographics, fistula characteristics including Parks' classification, smoking history, previous vaginal deliveries, diagnosis of Crohn's disease, Fecal Incontinence Severity Index, and operations performed were noted. A follow-up datasheet recorded postoperative complications, healing at one and three months, and postoperative continence scores. Factors associated with healing and treatment success were compared by use of Fisher's exact test.
Results:
Twenty-five surgeons at 13 hospitals entered 245 patients (162 male, 83 female) in the registry. Seventy-five patients had recurrent fistulas, 51 had multiple tracts, 62 were smokers, and 24 had Crohn's disease. The overall healing rate was 19.5% at one month and 63.2% at three months. Female gender (P=0.04) and recurrent fistula (P=0.03) were associated with nonhealing, and 28.4% of patients required additional surgery. The best healing rate was associated with fistulotomy (87%), whereas a plug had the worst healing rate (32%, P=0.001).
Conclusions:
Surgical treatment of an anal fistula is associated with a substantial risk of nonhealing at three months. Fistulotomy had a high success rate, whereas the bioprosthetic plug had the lowest success rate.
Multicenter studies comparing treatment options for similar fistulas are needed. |
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 疾病资源中心
病例分析 [栏目介绍]
王燕燕 王曙
上海交通大学附属瑞金医院内分泌科
患者，女，69岁。2009年1月无明显诱因下出现乏力，当时程度较轻，未予以重视。2009年3月患者乏力症状加重，尿色逐渐加深，大便习惯改变，颜色变淡。4月18日入我院感染科治疗，诉轻度头晕、心慌，体重减轻10kg。无肝区疼痛，无发热，无腹痛、腹泻、腹胀、里急后重，无恶性、呕吐等。入院半月前于外院就诊，查肝功能：ALT 601IU/L，AST 785IU/L，TBIL 97.7umol/L，白蛋白 41g/L，甲状腺功能：游离T3 30.6pmol/L，游离T4 51.9pmol/L，心电图示快速房颤。
医学数据库
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