intersphincteric fistula-in-ano
肛肠科常用疾病名称中英对照
混合痔 mixed hemorrhoid
肛裂 anal fissure
肛周脓肿 perianal abscess
肛门直肠脓肿 anorectal abscess
恶性淋巴瘤 maligmant lymphoma
表皮样囊肿 epidermoid cyst
皮脂囊肿 sebaceous cyst
脂肪瘤 lipoma
出口梗阻型便秘 outlet obstruction constipation，OOC
直肠前突 rectocele,RC
直肠内套叠 internai rectal intussusception，IRI
肛门狭窄 anal stenosis
肛门直肠狭窄 anus-rectal stenosis
肛门失禁（便失禁） fecal incontinence
直肠息肉 rectal polyp
结直肠癌 colorectal carcinoma
结肠类癌 carcinoid of the colon
结肠淋巴瘤 lymphoma of the colon
恶性黑色素瘤 melanoma
溃疡性结肠炎 ulcerative colitis,UC
克罗恩病 Crohn disease,CD
肠易激综合征 irritable bowel syndrome,IBS
放射性结肠炎 radiation colitis
耻骨直肠肌肥厚症 puborectalis ctalismuscle hypertrophy，PRMH
耻骨直肠肌综合征 puborectalis syndrome，PRS
会阴下降综合征 descending perineum syndrome，DPS
肛周脓肿和肛瘘诊治策略——解读美国和德国指南
Ｇｕｉｄｅｌｉｎｅ ｃｏｍｍｅｎｔａｒｙ
肛周脓肿和肛瘘是结直肠外科的常见病和多发病．有 ９０％是由于肛腺感染引起。依据循证医学证据，美国结直肠 医师协会于２０１ １年在其２００５年制订的临床指南基础上发
脓肿的类型选择合适的引流方式。（１）皮下或坐骨肛管（直 肠）脓肿：可做肛周切口，切口需与外括约肌纤维平行，引流 切口在不破坏括约肌的前提下应尽量接近肛缘．以缩短术 后可能形成的瘘管长度，并保证引流通畅；（２）括约肌间脓 肿：低位者行肛周切口引流或一次切开，完全位于括约肌间 靠近肛管可经肛引流。并切断部分内括约肌：（３）肛提肌上 脓肿：术前需超声定位，可经直肠引流．如合并坐骨直肠间 隙脓肿．可经肛引流．并在脓腔中置入引流管（如１０～１４
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引流。根据脓肿的位置选择经肛周或经直肠引流。根据症状 决定手术时机．多需急诊手术。 肛周脓肿的主要治疗仍是外科引流。充分麻醉下，依据
线常用于分期治疗。最初的挂线为了引流。需留置数周，待
二期行保留括约肌手术，如皮瓣推移、纤维蛋白胶、肛瘘栓 或经括约肌间瘘管结扎术。挂线有切割挂线．逐步紧线而使 瘘管逐渐切开。同时刺激管道瘢痕形成。大约需要数周；还 有松挂线，为了促进引流，避免肛周脓肿的复发，可能需要 长时间留置或至治愈后去除。关于挂线．目前缺少高质量的 数据支持，只有４组随机对照的研究。结果差异很大。切开 挂线术目前仍然是国内处理高位复杂性肛瘘的主流术式． 是治疗肛瘘最古老、也是最有生命力的术式之一．可根据引 流、切割、刺激和标志的不同目的灵活应用，可以分次、分时 段慢性切割挂线或引流挂线…。 经肛皮（黏膜）瓣推移术是游离近端一段肛管直肠的黏 膜、黏膜下和肌层组织覆盖缝合于内口上。本手术操作相对 比较复杂．如黏膜瓣的游离一定要包括黏膜下层和部分内 括约肌．需要一定经验．且国内因为肛周脓肿引流术不规 范．常因内口不确定或瘘管不成熟等因素影响该术式的使 用。术后总体复发率为１３％。５６％。在此基础上结合纤维蛋 白胶、肛瘘栓填充等方法并不能提高成功率。术后轻到中度 的失禁发生率为７％～３８％。 经括约肌间瘘管结扎术（ⅡＦｒ）治疗复杂性肛瘘。该技 术于２００７年由Ｒｏｊａｎａｓａｋｕｌ教授发明后逐渐引起关注并推 广使用。ＬＩｂ－Ｔ技术系经括约肌间分离切断结扎瘘管。经典步 骤为留置挂线８周以上使瘘道纤维化后运用此方法。将标 记好的瘘道经括约肌间分离、结扎．关闭内口，扩大外口以 利引流。不损伤肛门括约肌。该术式具有新手术入路、保留 括约肌和费用低等优点，极具吸引力。虽然文献中数据仍较 少，但瘘管闭合的成功率为５７％，９４％：平均随访时间３～８ 个月，复发率仅为６％～１８％。在３项主要研究数据中，没有 出现排粪失禁和其他并发症。该技术适合我国国情．相信随 着学习曲线和逐步推广，应具有很好的前景［１０］。在此基础上 发展的ＢｉｏｕＦＴ手术是否更优．尚待观察…］。 清创术和注射纤维蛋白胶和肛瘘栓治疗复杂性肛瘘． 虽然成功率相对较低．但术后并发症发生率低．仍可作为选 择术式。目前在国内的运用，因为成功率低和费用相对昂 贵．尚难作为一线治疗方法［７Ｊ。 ３．克罗恩病肛瘘：无症状者无需手术：有症状的低位单 纯性肛瘘可行切开术；复杂性肛瘘可长期挂线引流：如果直 肠黏膜大体正常．可行皮（黏膜）瓣推移术。对不能控制症状
手术名英语
食道肌切开术Esophageal myomectomy食道憩窒切除术Excision of esophageal diverticulum食道内腔置管术Endoesophageal intubation食道胃底改道术Esophagofundostomy bypass食道胃底吻合术Esophagofundostomy食道胃改道术Esophagogastrostomy bypass抗胃食道逆流术Blesy's mark iv anti-reflex procedure逆行食道扩张术Retrograde esophageal dilatation（esophagectasia，retrograde）食道、胃瘘管缝合术Esophagogastric fistula closure食道切除术Esophagectomy食道切除再造术Esophagectomy&reconstruction食道切开术Esophagotomy食道瘤及囊肿切除术Excision of esophageal cyst&tumor食道再造术——以胃管重建Esophageal reconstruction with gastrictube食道再造术——以大肠重建Esophageal reconstruction with colon食道再造术——以小肠重建Esophagel reconstruction with smallintestine食道裂伤修补术Repair of esophageal laceration一般性食道癌摘除术（含淋巴节清扫）Simple excision of esophageal cancer，with lymphadenectomy复杂性食道癌摘除术（含淋巴节清扫）Complicated excision of esophagealcancer，with lymphadenectomy食道静脉瘤曲张结扎，经胸或经腹Ligation of esophageal varices，transthoracic or transabdominal食道静脉瘤曲张结扎，脾脏切除并近心端胃血管去除－经胸Devascularization procedure——transthoracic食道静脉瘤曲张结扎，脾脏切除并近心端胃血管去除－经腹Devascularization procedure——transabdominal胃食道内管留置（胃贲门癌或食道癌）Esophagogastric stent for esophagus orcardia portion cancer胃切开术－探查性Gastrotomy——exploration胃切开术－异物移除Gastrotomy——removal of foreign body胃切开术－溃疡缝合及止血Gastrotomy——with suture repair of bleedingulcer幽门肌肉切开术（Fredet-Ramstedt型手术）Pyloromyotomy，Fredet-Ramstedt胃溃疡或肿瘤的局部切除Local excision，ulcer or tumor胃全部切除术Gastrectomy，total&angreconstruction胃造瘘术及幽门成形术Gastrostomy&pyloroplasty次全或半胃切除术及胃十二指肠吻合术－无迷走神经切除Subtotal gastrectomy or hemigastrectomy withgastro-duodenostomy without vagotomy次全或半胃切除术及胃空肠吻合术－无迷走神经切除Subtotal gastrectomy or hemigastrectomy withgastrojejunostomy without vagotomy次全或半胃切除术及胃空肠吻合术Roux-en-Y型－无迷走神经切除補英文次全或半胃切除术－伴有迷走神经切除Gastrectomy，subtotal or hemigastrectomy——with vagotomy迷走神经切断术加幽门成形术Vagotomy and pyloroplasty幽门成形术Pyloroplasty胃十二指肠造口吻合术Gastro-duodenostomy胃空肠造口吻合术Gastrojejunostomy胃小肠造口吻合术Gastroenterostomy胃空肠造口吻合术（伴有迷走神经切断术）Gastrojejunostomy with vagotomy胃造口术——暂时性Gastrostomy（plastic tube）十二指肠缝合术（十二指肠溃疡穿孔的缝合）Duodenorrhpahy，suture of perforated ulcer胃缝合术（胃溃疡穿孔及胃部伤口的缝合）Gastrorrhaphy，suture or repair wound，injury perforated ulcer of stomach胃十二指肠造口再修正并或不并迷走神经切除Revision of gastroduodenostomy with or without vagotomy胃切除后因出血而再剖开Re-exploration for postgastrectomy bleeding胃造口闭口Closure of gastrostomy 十二指肠造口术Duodenostomy十二指肠肿瘤切除Excision of duodenum tumor十二指肠憩室切除或内翻Excision or inversion of duodenaldiverticulum十二指肠瘘管闭合Closure of duodenal fistula十二指肠阻塞Duodenal obstruction高度选择性迷走神经切断术Highly selective vagotomy迷走神经切断术Vagotomy胃贲门及食道切除再造术Proximalgastrectomy&esophagectomy&reconstruction胃全部切除术并行脾或部份胰切除Gastrectomy，total，with splenectomy orpartital pancreatectomy全胃切除及淋巴清除及肠胃重建Total gastrectomy，with LN dissection，with reconstruction（any type）95%胃切除及淋巴清除及肠胃重建次全胃切除及淋巴清除及肠胃重建胃空肠造口再修正Revision of gastrojejunostomy残留胃窦切除术Resection of retained antrum，postgastrectomy胃隔间手术-垂直及圈带式胃整型术Gastric partition，vertical banded gastroplasty经十二指肠括约肌成形术Transduodenal sphinteroplasty胃折迭术Plication of stomach胃固定术（胃扭结）Gastropexy for gastric volvulus消化道华达壶腹切开术EPT（endoscopic papillectomy）腹腔镜胃隔间手术Laparoscopic gastric partition肠粘连分离术Enterolysis，freeing adhesion肠粘连分离术－并行肠减压Enterolysis——with bowel decompression肠粘连分离术－并有肠切除及吻合Enterolysis——with resection&anastomosis ofintestine肠外置术（Mikulicz切除）Exteriorization of intestine，Mikulicz resection肠套迭之还原Reduction of intussusception肠套迭还原及肠切除和吻合Reduction of intussusception with bowelresection&anastomosis肠套迭还原及肠造口或结肠造口Reduction of intussusception with enterostomy or colostomy良性肠病灶切除术Excision，Benign bowel lesion迈克氏憩室切除术Meckel's diverticulectomy小肠切除术加吻合术Resection of small bowel，with anastomosis结肠部分切除术加吻合术Colectomy，partial，with anastomosis根治性半结肠切除术加吻合术，升结肠Colectomy，radical hemicolectomy with anastomosis，ascending colon降结肠或乙状结肠切除术加吻合术Left hemicolectomy or sigmoid colectomy降结肠或乙状结肠切除术并行吻合术及淋巴节清扫Left hemicolectomy or sigmoid colectomy with anastomosis with lymph node结肠全切或次全切除术Colectomy，total or subtotal结肠全切除术并行直肠切除术及回肠造口Colectomy，total with proctectomy，with ileostomy 单纯性结肠造口或肠造口矫正Revision of colostomy or enterostomy simple，superficial. 复杂性（进入腹腔）结肠造口或肠造口矫正Revision of colostomy or enterostomycomplicated，deep.肠反逆流合术Antireflex produce in the intestine蹄形小肠或结肠造瘘管关闭Closure of enterostomy or Colostomy（loop or double-barrel）肠造口术（包括结肠、空肠、永久性小肠）Enterostomy（including colostomy、Jujunostomy、permanent enterostomy）小肠瘘管关闭术－小肠与皮肤Closure of intestinal fistula——Enterocutaneous小肠瘘管关闭术－小肠与结肠（或与小肠）Closure of intestinal fistula——entero-colic or entero-entero小肠瘘管关闭术－其它器官或包括合并症Closure of intestinal fistula——fistula ofbowel with other organs or complicated结肠瘘管关闭术－结肠与皮肤Closure of colon fistula——colocutaneous结肠瘘管关闭术－胃与结肠（不包括胃切除）Closure of colon fistula——gastroclic withoutgastrectomy结肠瘘管关闭术－胃与结肠（包括胃切除）Closure of colon fistula——gastroclic withgastrectomy结肠瘘管关闭术－结肠与其它器官或合并症Closure of colon fistula——fistula of colon withother organs or complicated肠吻合术－小肠与小肠（十二指肠）吻合术Anastomosis of bowel——entero-enterostomy orduodeno-enterostomy肠吻合术－回肠与结肠吻合术，有间路法Anastomosis of bowel——Anastomosis of bowel，ileo-colostomy，with bypass肠吻合术－由小肠闭锁或狭窄引起Anastomosis of bowel——for intestinal atresia orstenosis小肠穿孔缝补术Repair of intestinal perforation肠系膜之缝合及修补Suture and repair of mesentery小肠瘜肉切除术Resection of intestinal polyp小肠折瘘术Intestinal plication，Noble type管肠造口或管盲肠造口Tube enterostomy or tube cecostomy肠吻合处切除，吻合重建术Take down of anastomosis，revision of ileo-colostomy and reconstruction回肠尿液引流袋修正术Revision of ileasl conduit经由剖腹术行小肠或结肠造瘘管关闭及吻合Closure of enterostomy or colostomy anastomosis，by laparotomy阑尾脓疡之引流Drainage of appendiceal abscess transabdominal阑尾切除术Appendectomy阑尾瘘管关闭Closure of appendiceal fistula单纯性直肠周围脓疡之切开引流Incision and drainage for perirectal or perianal abscess复杂性直肠周围脓疡之切开引流（包括福尼尔氏肌膜炎坏死）Incision and drainage for Complicated perirectal abscess（ischiorectal，high intersphincteric，deep postanal，supralevator abscess，Fournier's gangrene）直肠活体组织切片Rectal incisional biopsy直肠裂伤或损伤之修补Repair of rectal laceration or injury直肠固定术Thiersh or Delorme，Rectopexy bystitches fixation根治性直肠切除术（含骨盆腔淋巴腺切除术）Radical protectomy with pelvic lymphnode dissectionHartmann氏直肠手术Harmann operation经直肠大肠息肉切除术Transrectal colonic Polypectomy直肠脱出根治手术（经会阴接近及吻合）Rectal procidentia，perineal approach，with resection&anastomosis直肠脱出手术（腹部接近）Rectal procidentia，abdominal approach荐骨与尾骨肿瘤切除，良性Excision，sacrococcygeal tumor，benign直肠上皮绒毛腺肿广泛性切除术或癌症局部切除Extensive excision of sacrococcygealrectal villous adenoma or malignancy直肠狭窄整形术Rectoplasty for stricture or stenosis复原性直肠切除以及直肠、肛门吻合术Restorative proctectomy with colo-analanastomosis复原性大肠直肠切除回肠储存袋以及回肠肛门吻合术Restorative proctocolectomy，pelvic ileal pouchwith ileoanal anastomosis直肠膀胱瘘管切除术Closure fistula，reco-vesical直肠癌腹部会阴联合切除术Combined abdomino perineal resection for rectalcancer乙状结肠及直肠切除后Pull through方法行直肠肛门吻合术Proctosigmoidectomy with pull through colon analanastomosis乙状结肠及直肠切除后Pull through方法行结肠造袋及结肠袋肛门吻合术Proctosigmoidectomy with pull through colon analanastomosis，reconstruction with colonic pouch经尾骨由直肠后部切开行良性病灶切除方法Posterior proctotomy，transacrococcygeal excisionof benign lesion.经尾骨由直肠后部切开行直肠癌切除方法Posterior proctotomy，transacrococcygeal resectionof malignant tumor皮下瘘管切开术或切除术Fistulotomy or fistulectomy，simple，subcutaneous肛门括约肌切开术Sphincterotomy，anal肛门裂缝切除术或溃疡切除术fissurectomy or ulcerectomy，anal隐窝切除术－单一Cryptectomy——single隐窝切除术－多数Cryptectomy——multiple外痔完全切除术Hemorrhoidectomy，external内外痔部份切除术Hemorrhoidectomy，partial，internal&external 肛门乳突切除术－单一Papillectomy anal——single肛门乳突切除术－多数Papillectomy anal——multiple内外痔完全切除术Hemorrhoidectomy，internal&external肛门瘘切除或切开术并痔疮切除Anal fistulectomy or fistulotomy with hemorrhoidectomy外痔血栓切除Thrombectomy，external hemorrhoid肛门狭窄整形术Anoplasty for stricture or imperforate肛门括约肌失禁整形术Sphincteroplasty for anal incontinenceAPR术后Karlex海棉除去术Removal of Karlex sponge s/p APR结肠肛门止血术Check anal or colon bleeding内痔结扎Internal hemorrhoid ligation 肛门重建或整形术以S形蒂状移植Anal reconstruction or anoplasty withS-pedicle graft提肛肌折迭术Levator plication procedure复杂性皮下瘘管切开术或切除术Fistulotomy or fistulectomy，complicated，subcutaneous楔状活体切片（剖腹探查术）Wedge biopsy of liver，laparotomy肝部分切除术Partial hepatectomy肝区域切除术－一区域Segemental hepatectomy——onesegement肝区域切除术－二区域Segemental hepatectomy——twosegements肝区域切除术－三区域Segemental hepatectomy——threesegements肝囊肿或肝脓疡引流或造袋术Drainage or marsupialization of cyst orabscess of liver缝肝术（肝损伤缝合，小于5公分）Hepatorrhaphy，suture of liverwound<5cm缝肝术及总胆管或胆囊之引流术Hepatorrhaphy，with common duct or gallbladderdrainage缝肝术（复杂肝损伤之缝合或大于5公分）Hepatorrhaphy，suture of liver wound，complicatedor>5cm肝动脉结扎Hepatic artery ligation for liver bleeding肝肠吻合Hepato-Enterostomy（Longmire Op.）肝门静脉分流术Portocavo shunt（H-graft）Warren氏分流术Warren's shunt右肝叶切除术Total right lobectomy左肝叶切除术Total left lobectomy扩大右肝叶切除术Extended right lobectomy扩大左肝叶切除术Extended left lobectomy切肝取石术Hepaticotomy or hepaticostomy，Removal ofCalculus肝脏移植Liver（Hepatic）transplantation尸体捐肝摘取Cadaveric liver harvest（donor hepatectomy）活体捐肝摘取Partial hepatectomy for livingrelated liver transplantation胆囊造瘘术Cholecystostomy胆管截石术（经十二指肠）Cholecystolithotomy（transduodenal）胆囊切除术Cholecystectomy胆囊切除术及术中胆管摄影Cholecystectomy and cholangiography腹腔镜胆囊切除术Laparoscopic cholecystectomy总胆管空肠吻合术CholedochojejunostomyROUX-EN-Y总肝管肠吻合术ROUX-EN-Yhepaticojejunostomy胆囊消化管吻合术Cholecystoenterostomy总胆管全切除术Total excision of common bile duct总胆管切开及T形管引流Choledochotomy with T-tube drainage总胆管切开摘石术及T形管引流Choledocholithotomy with T-tube drainage胆管成形术Choledochoplasty胆道组织检查切片术Biopsy of biliary tract总胆管十二指肠吻合术Choledochoduodenostomy肝外胆管成形术Plasty of extrahepatic bile duct肝瘘管缝合术Closure of biliary fistula胰脏脓疡或胰炎引流术Drainage of pancreatic abscess or cyst orpancreatitis胰组织检查切片Pancreas incisional biopsy胰脏肿瘤或囊肿切除或摘除术Excision or enucleation of pancreatictumor or cyst胰脏尾端部分切除术Distal partial pancreatectomy胰脏尾端部分切除术-脾脏保留補英文胰脏体部分切除术Body partial pancreatectomy胰脏体部分切除术-脾脏保留補英文胰瘘切除术Pencreatic fistulectomy胰囊肿至肠胃道之内部直接引流吻合术Anastomosis of pancreatic cyst to GI tractdirect internal drainage胰囊肿至肠胃道之Y型内部吻合术Anastomosis of pancreatic cyst to GI tractdirectinternal drainage（Roux-en-Y）胰脏结石去除术Removal pancreatic calculus胰脏次全切除术Pancreatectomy subtotal胰脏全切除术Total pancreatectomy（95%）Whipple氏胰、十二指肠切除术Pancreatico-duodenectomy，Whipple type，withreconstructionWhipple氏胰、十二指肠切除术幽门保留式Pancreatico-duodenectomy，Whipple type，withreconstruction（pylorus sparing whipple op）胰脏空肠吻合术Pancreatico-Jejunostomy胰囊肿造袋术Marsupialization of pancreatic cyst腹壁脓疡引流术Drainage of abdominal wall abscess腹腔脓疡灌洗腹壁肿瘤切除术－良性Excision of abdominal wall tumor——benign腹壁肿瘤切除术－恶性Excision of abdominal wall tumor——malignant腹壁疝气修补术－并肠切除Repair of ventral hernia——with bowel resection腹壁疝气修补术－无肠切除Repair of ventral hernia——without bowel resection腹壁疝气修补术，嵌顿性，－无肠切除腹壁疝气修补术，复发性－无肠切除鼠蹊疝气修补术－并肠切除Repair of inguinal hernia——with bowel resection 鼠蹊疝气修补术－无肠切除Repair of inguinal hernia——without bowel resection鼠蹊疝气修补术，嵌顿性，－无肠切除鼠蹊疝气修补术，复发性，－无肠切除股疝气修补术－无肠切除腰椎疝气修补术Repair of lumbar hernia腹腔镜疝气修补术Herniorraphy腹腔内脓疡引流术治疗急性穿孔性腹膜炎Drainage of intraabdominal abscess for acute perforation peritonitis膈下脓疡引流术Drainage of subphrenic abscess骨盆腔脓疡引流术－经腹Drainage of pelvic abscess——transabdominal骨盆腔脓疡引流术－经肛门Drainage of pelvic abscess——transanal剖腹探查术Exploratory laparotomy 腹腔良性肿瘤切除术Excision of intraabdominal tumor，benign后腹腔良性肿瘤切除术Excision of retroperitoneal tumor，benign腹腔内异物却除术Removal of intraabdominal foreign body后腹腔剖腹探查术Retroperitoneal exploratory laparotomy腹腔恶性肿瘤切除术Excision of intraabdominal tumor，malignant后腹腔恶性肿瘤切除术并后腹腔淋巴腺摘除术Excision of retroperitoneal tumor，malignant with retroperitoneallymphadenectomy腹腔静脉分流术Peritoneo-Venous shunt脐尿管或瘘管切除术与部分胆囊切除术Excision of Urachal duct or fistula withpartial cholecystectomy腹壁损伤修复术－简单Repair of abdominal wall injury——simple with/without reconstruction腹壁损伤修复术－广泛性Repair of abdominal wall injury——extensive with reconstruction or prosthesis腹壁缝合裂开剜脏术，第二次缝合Suture of abdominal wall for evisceration ofdehiscence for secondary closure。
12.肛瘘的微创治疗进展
肛瘘的微创治疗进展史瑞霞1王业皇2（1南京中医药大学；2南京中医药大学附属第三医院南京市中医院江苏南京210001）肛瘘是一种常见疾病，令患者痛苦不堪，患病率为8．6/10万人[1]。
在我国发病率约占肛肠病的1．7%～3．6%[2]。
近年来，随着新的手术方法的应用、微创外科观念的深入，治疗肛瘘的微创化低侵袭术式越来越多的医者在提倡并积极探索，怎样在保证其疗效的前提下，最大限度地保留肛门括约肌，维持肛门的正常功能，减少了手术对肛周组织的损伤，成为医生和患者共同关心的问题。
现就近年来国内外肛瘘的微创治疗进展作一综述。
1.肛瘘的概念肛瘘是肛管直肠与肛周皮肤相通的一种异常通道,是肛周脓肿的慢性化阶段[3],其临床表现特点主要为肛门硬结、局部反复破溃流脓、疼痛、潮湿及瘙痒等。
2.肛瘘的分类2.1国内分类参考中华中医药学会肛肠分会、中华医学会外科学分会结直肠肛门外科学组、中国中西医结合学会大肠肛门病专业委员会制定的《肛瘘临床诊治指南(2006版)》。
1)低位肛瘘:分为低位单纯性肛瘘和低位复杂性肛瘘。
2)高位肛瘘:分为高位单纯性肛瘘和高位复杂性肛瘘。
2.2Parks分类肛瘘的分类取决于瘘管与肛门括约肌的关系,分为括约肌间型、经括约肌型、括约肌上方型、括约肌外型。
当瘘管穿越外括约肌的30% ~50%以上(高位括约肌间、括约肌上方、括约肌外方),女性前侧瘘管,多个瘘管,复发性瘘管,或伴有肛门失禁,或治疗后可能引起肛门失禁的肛瘘均认为复杂性肛瘘。
3.肛瘘的微创治疗3.1纤维蛋白胶封堵术其手术关键是：在正确彻底清除内口和管壁坏死组织的前提下，应用生物蛋白胶彻底粘堵内口，封闭瘘管，以达到瘘管的闭合。
该术式因其不损伤肛门括约肌，操作简单，无明显后遗症，可重复治疗，因而在国外应用较为广泛。
该术式成功率报道不一，Abel[4]和Cintron[5]应用人体自身纤维组织粘结剂填充瘘管治疗低位肛瘘总的有效率可达82%。
但Oded Zmora和Wexner[6]等在他们的研究中发现生物蛋白胶在治疗会阴部肛瘘只有一个中等的治愈率(33%),但是他们认为这种方法技术简单,肛门括约肌损伤的机率小,可以作为复杂肛瘘的比较理想的治疗手段。
手术名--英语
食道肌切开术Esophageal myomectomy食道憩窒切除术Excision of esophageal diverticulum食道内腔置管术Endoesophageal intubation食道胃底改道术Esophagofundostomy bypass食道胃底吻合术Esophagofundostomy食道胃改道术Esophagogastrostomy bypass抗胃食道逆流术Blesy's mark iv anti-reflex procedure逆行食道扩张术Retrograde esophageal dilatation（esophagectasia，retrograde）食道、胃瘘管缝合术Esophagogastric fistula closure食道切除术Esophagectomy食道切除再造术Esophagectomy&reconstruction食道切开术Esophagotomy食道瘤及囊肿切除术Excision of esophageal cyst&tumor食道再造术——以胃管重建Esophageal reconstruction with gastrictube食道再造术——以大肠重建Esophageal reconstruction with colon食道再造术——以小肠重建Esophagel reconstruction with smallintestine食道裂伤修补术Repair of esophageal laceration一般性食道癌摘除术（含淋巴节清扫）Simple excision of esophageal cancer，with lymphadenectomy复杂性食道癌摘除术（含淋巴节清扫）Complicated excision of esophagealcancer，with lymphadenectomy食道静脉瘤曲张结扎，经胸或经腹Ligation of esophageal varices，transthoracic or transabdominal食道静脉瘤曲张结扎，脾脏切除并近心端胃血管去除－经胸Devascularization procedure——transthoracic食道静脉瘤曲张结扎，脾脏切除并近心端胃血管去除－经腹Devascularization procedure——transabdominal胃食道内管留置（胃贲门癌或食道癌）Esophagogastric stent for esophagus orcardia portion cancer胃切开术－探查性Gastrotomy——exploration胃切开术－异物移除Gastrotomy——removal of foreign body胃切开术－溃疡缝合及止血Gastrotomy——with suture repair of bleedingulcer幽门肌肉切开术（Fredet-Ramstedt型手术）Pyloromyotomy，Fredet-Ramstedt胃溃疡或肿瘤的局部切除Local excision，ulcer or tumor胃全部切除术Gastrectomy，total&angreconstruction胃造瘘术及幽门成形术Gastrostomy&pyloroplasty次全或半胃切除术及胃十二指肠吻合术－无迷走神经切除Subtotal gastrectomy or hemigastrectomy withgastro-duodenostomy without vagotomy次全或半胃切除术及胃空肠吻合术－无迷走神经切除Subtotal gastrectomy or hemigastrectomy withgastrojejunostomy without vagotomy次全或半胃切除术及胃空肠吻合术Roux-en-Y型－无迷走神经切除補英文次全或半胃切除术－伴有迷走神经切除Gastrectomy，subtotal or hemigastrectomy——with vagotomy迷走神经切断术加幽门成形术Vagotomy and pyloroplasty幽门成形术Pyloroplasty胃十二指肠造口吻合术Gastro-duodenostomy胃空肠造口吻合术Gastrojejunostomy胃小肠造口吻合术Gastroenterostomy胃空肠造口吻合术（伴有迷走神经切断术）Gastrojejunostomy with vagotomy胃造口术——暂时性Gastrostomy（plastic tube）十二指肠缝合术（十二指肠溃疡穿孔的缝合）Duodenorrhpahy，suture of perforated ulcer胃缝合术（胃溃疡穿孔及胃部伤口的缝合）Gastrorrhaphy，suture or repair wound，injury perforated ulcer of stomach胃十二指肠造口再修正并或不并迷走神经切除Revision of gastroduodenostomy with or without vagotomy胃切除后因出血而再剖开Re-exploration for postgastrectomy bleeding胃造口闭口Closure of gastrostomy 十二指肠造口术Duodenostomy十二指肠肿瘤切除Excision of duodenum tumor十二指肠憩室切除或内翻Excision or inversion of duodenaldiverticulum十二指肠瘘管闭合Closure of duodenal fistula十二指肠阻塞Duodenal obstruction高度选择性迷走神经切断术Highly selective vagotomy迷走神经切断术Vagotomy胃贲门及食道切除再造术Proximalgastrectomy&esophagectomy&reconstruction胃全部切除术并行脾或部份胰切除Gastrectomy，total，with splenectomy orpartital pancreatectomy全胃切除及淋巴清除及肠胃重建Total gastrectomy，with LN dissection，with reconstruction（any type）95%胃切除及淋巴清除及肠胃重建次全胃切除及淋巴清除及肠胃重建胃空肠造口再修正Revision of gastrojejunostomy残留胃窦切除术Resection of retained antrum，postgastrectomy胃隔间手术-垂直及圈带式胃整型术Gastric partition，vertical banded gastroplasty经十二指肠括约肌成形术Transduodenal sphinteroplasty胃折迭术Plication of stomach胃固定术（胃扭结）Gastropexy for gastric volvulus消化道华达壶腹切开术EPT（endoscopic papillectomy）腹腔镜胃隔间手术Laparoscopic gastric partition肠粘连分离术Enterolysis，freeing adhesion肠粘连分离术－并行肠减压Enterolysis——with bowel decompression肠粘连分离术－并有肠切除及吻合Enterolysis——with resection&anastomosis ofintestine肠外置术（Mikulicz切除）Exteriorization of intestine，Mikulicz resection肠套迭之还原Reduction of intussusception肠套迭还原及肠切除和吻合Reduction of intussusception with bowelresection&anastomosis肠套迭还原及肠造口或结肠造口Reduction of intussusception with enterostomy or colostomy良性肠病灶切除术Excision，Benign bowel lesion迈克氏憩室切除术Meckel's diverticulectomy小肠切除术加吻合术Resection of small bowel，with anastomosis结肠部分切除术加吻合术Colectomy，partial，with anastomosis根治性半结肠切除术加吻合术，升结肠Colectomy，radical hemicolectomy with anastomosis，ascending colon降结肠或乙状结肠切除术加吻合术Left hemicolectomy or sigmoid colectomy降结肠或乙状结肠切除术并行吻合术及淋巴节清扫Left hemicolectomy or sigmoid colectomy with anastomosis with lymph node结肠全切或次全切除术Colectomy，total or subtotal结肠全切除术并行直肠切除术及回肠造口Colectomy，total with proctectomy，with ileostomy 单纯性结肠造口或肠造口矫正Revision of colostomy or enterostomy simple，superficial. 复杂性（进入腹腔）结肠造口或肠造口矫正Revision of colostomy or enterostomycomplicated，deep.肠反逆流合术Antireflex produce in the intestine蹄形小肠或结肠造瘘管关闭Closure of enterostomy or Colostomy（loop or double-barrel）肠造口术（包括结肠、空肠、永久性小肠）Enterostomy（including colostomy、Jujunostomy、permanent enterostomy）小肠瘘管关闭术－小肠与皮肤Closure of intestinal fistula——Enterocutaneous小肠瘘管关闭术－小肠与结肠（或与小肠）Closure of intestinal fistula——entero-colic or entero-entero小肠瘘管关闭术－其它器官或包括合并症Closure of intestinal fistula——fistula ofbowel with other organs or complicated结肠瘘管关闭术－结肠与皮肤Closure of colon fistula——colocutaneous结肠瘘管关闭术－胃与结肠（不包括胃切除）Closure of colon fistula——gastroclic withoutgastrectomy结肠瘘管关闭术－胃与结肠（包括胃切除）Closure of colon fistula——gastroclic withgastrectomy结肠瘘管关闭术－结肠与其它器官或合并症Closure of colon fistula——fistula of colon withother organs or complicated肠吻合术－小肠与小肠（十二指肠）吻合术Anastomosis of bowel——entero-enterostomy orduodeno-enterostomy肠吻合术－回肠与结肠吻合术，有间路法Anastomosis of bowel——Anastomosis of bowel，ileo-colostomy，with bypass肠吻合术－由小肠闭锁或狭窄引起Anastomosis of bowel——for intestinal atresia orstenosis小肠穿孔缝补术Repair of intestinal perforation肠系膜之缝合及修补Suture and repair of mesentery小肠瘜肉切除术Resection of intestinal polyp小肠折瘘术Intestinal plication，Noble type管肠造口或管盲肠造口Tube enterostomy or tube cecostomy肠吻合处切除，吻合重建术Take down of anastomosis，revision of ileo-colostomy and reconstruction回肠尿液引流袋修正术Revision of ileasl conduit经由剖腹术行小肠或结肠造瘘管关闭及吻合Closure of enterostomy or colostomy anastomosis，by laparotomy阑尾脓疡之引流Drainage of appendiceal abscess transabdominal阑尾切除术Appendectomy阑尾瘘管关闭Closure of appendiceal fistula单纯性直肠周围脓疡之切开引流Incision and drainage for perirectal or perianal abscess复杂性直肠周围脓疡之切开引流（包括福尼尔氏肌膜炎坏死）Incision and drainage for Complicated perirectal abscess（ischiorectal，high intersphincteric，deep postanal，supralevator abscess，Fournier's gangrene）直肠活体组织切片Rectal incisional biopsy直肠裂伤或损伤之修补Repair of rectal laceration or injury直肠固定术Thiersh or Delorme，Rectopexy bystitches fixation根治性直肠切除术（含骨盆腔淋巴腺切除术）Radical protectomy with pelvic lymphnode dissectionHartmann氏直肠手术Harmann operation经直肠大肠息肉切除术Transrectal colonic Polypectomy直肠脱出根治手术（经会阴接近及吻合）Rectal procidentia，perineal approach，with resection&anastomosis直肠脱出手术（腹部接近）Rectal procidentia，abdominal approach荐骨与尾骨肿瘤切除，良性Excision，sacrococcygeal tumor，benign直肠上皮绒毛腺肿广泛性切除术或癌症局部切除Extensive excision of sacrococcygealrectal villous adenoma or malignancy直肠狭窄整形术Rectoplasty for stricture or stenosis复原性直肠切除以及直肠、肛门吻合术Restorative proctectomy with colo-analanastomosis复原性大肠直肠切除回肠储存袋以及回肠肛门吻合术Restorative proctocolectomy，pelvic ileal pouchwith ileoanal anastomosis直肠膀胱瘘管切除术Closure fistula，reco-vesical直肠癌腹部会阴联合切除术Combined abdomino perineal resection for rectalcancer乙状结肠及直肠切除后Pull through方法行直肠肛门吻合术Proctosigmoidectomy with pull through colon analanastomosis乙状结肠及直肠切除后Pull through方法行结肠造袋及结肠袋肛门吻合术Proctosigmoidectomy with pull through colon analanastomosis，reconstruction with colonic pouch经尾骨由直肠后部切开行良性病灶切除方法Posterior proctotomy，transacrococcygeal excisionof benign lesion.经尾骨由直肠后部切开行直肠癌切除方法Posterior proctotomy，transacrococcygeal resectionof malignant tumor皮下瘘管切开术或切除术Fistulotomy or fistulectomy，simple，subcutaneous肛门括约肌切开术Sphincterotomy，anal肛门裂缝切除术或溃疡切除术fissurectomy or ulcerectomy，anal隐窝切除术－单一Cryptectomy——single隐窝切除术－多数Cryptectomy——multiple外痔完全切除术Hemorrhoidectomy，external内外痔部份切除术Hemorrhoidectomy，partial，internal&external 肛门乳突切除术－单一Papillectomy anal——single肛门乳突切除术－多数Papillectomy anal——multiple内外痔完全切除术Hemorrhoidectomy，internal&external肛门瘘切除或切开术并痔疮切除Anal fistulectomy or fistulotomy with hemorrhoidectomy外痔血栓切除Thrombectomy，external hemorrhoid肛门狭窄整形术Anoplasty for stricture or imperforate肛门括约肌失禁整形术Sphincteroplasty for anal incontinenceAPR术后Karlex海棉除去术Removal of Karlex sponge s/p APR结肠肛门止血术Check anal or colon bleeding内痔结扎Internal hemorrhoid ligation 肛门重建或整形术以S形蒂状移植Anal reconstruction or anoplasty withS-pedicle graft提肛肌折迭术Levator plication procedure复杂性皮下瘘管切开术或切除术Fistulotomy or fistulectomy，complicated，subcutaneous楔状活体切片（剖腹探查术）Wedge biopsy of liver，laparotomy肝部分切除术Partial hepatectomy肝区域切除术－一区域Segemental hepatectomy——onesegement肝区域切除术－二区域Segemental hepatectomy——twosegements肝区域切除术－三区域Segemental hepatectomy——threesegements肝囊肿或肝脓疡引流或造袋术Drainage or marsupialization of cyst orabscess of liver缝肝术（肝损伤缝合，小于5公分）Hepatorrhaphy，suture of liverwound<5cm缝肝术及总胆管或胆囊之引流术Hepatorrhaphy，with common duct or gallbladderdrainage缝肝术（复杂肝损伤之缝合或大于5公分）Hepatorrhaphy，suture of liver wound，complicatedor>5cm肝动脉结扎Hepatic artery ligation for liver bleeding肝肠吻合Hepato-Enterostomy（Longmire Op.）肝门静脉分流术Portocavo shunt（H-graft）Warren氏分流术Warren's shunt右肝叶切除术Total right lobectomy左肝叶切除术Total left lobectomy扩大右肝叶切除术Extended right lobectomy扩大左肝叶切除术Extended left lobectomy切肝取石术Hepaticotomy or hepaticostomy，Removal ofCalculus肝脏移植Liver（Hepatic）transplantation尸体捐肝摘取Cadaveric liver harvest（donor hepatectomy）活体捐肝摘取Partial hepatectomy for livingrelated liver transplantation胆囊造瘘术Cholecystostomy胆管截石术（经十二指肠）Cholecystolithotomy（transduodenal）胆囊切除术Cholecystectomy胆囊切除术及术中胆管摄影Cholecystectomy and cholangiography腹腔镜胆囊切除术Laparoscopic cholecystectomy总胆管空肠吻合术CholedochojejunostomyROUX-EN-Y总肝管肠吻合术ROUX-EN-Yhepaticojejunostomy胆囊消化管吻合术Cholecystoenterostomy总胆管全切除术Total excision of common bile duct总胆管切开及T形管引流Choledochotomy with T-tube drainage总胆管切开摘石术及T形管引流Choledocholithotomy with T-tube drainage胆管成形术Choledochoplasty胆道组织检查切片术Biopsy of biliary tract总胆管十二指肠吻合术Choledochoduodenostomy肝外胆管成形术Plasty of extrahepatic bile duct肝瘘管缝合术Closure of biliary fistula胰脏脓疡或胰炎引流术Drainage of pancreatic abscess or cyst orpancreatitis胰组织检查切片Pancreas incisional biopsy胰脏肿瘤或囊肿切除或摘除术Excision or enucleation of pancreatictumor or cyst胰脏尾端部分切除术Distal partial pancreatectomy胰脏尾端部分切除术-脾脏保留補英文胰脏体部分切除术Body partial pancreatectomy胰脏体部分切除术-脾脏保留補英文胰瘘切除术Pencreatic fistulectomy胰囊肿至肠胃道之内部直接引流吻合术Anastomosis of pancreatic cyst to GI tractdirect internal drainage胰囊肿至肠胃道之Y型内部吻合术Anastomosis of pancreatic cyst to GI tractdirectinternal drainage（Roux-en-Y）胰脏结石去除术Removal pancreatic calculus胰脏次全切除术Pancreatectomy subtotal胰脏全切除术Total pancreatectomy（95%）Whipple氏胰、十二指肠切除术Pancreatico-duodenectomy，Whipple type，withreconstructionWhipple氏胰、十二指肠切除术幽门保留式Pancreatico-duodenectomy，Whipple type，withreconstruction（pylorus sparing whipple op）胰脏空肠吻合术Pancreatico-Jejunostomy胰囊肿造袋术Marsupialization of pancreatic cyst腹壁脓疡引流术Drainage of abdominal wall abscess腹腔脓疡灌洗腹壁肿瘤切除术－良性Excision of abdominal wall tumor——benign腹壁肿瘤切除术－恶性Excision of abdominal wall tumor——malignant腹壁疝气修补术－并肠切除Repair of ventral hernia——with bowel resection腹壁疝气修补术－无肠切除Repair of ventral hernia——without bowel resection腹壁疝气修补术，嵌顿性，－无肠切除腹壁疝气修补术，复发性－无肠切除鼠蹊疝气修补术－并肠切除Repair of inguinal hernia——with bowel resection 鼠蹊疝气修补术－无肠切除Repair of inguinal hernia——without bowel resection鼠蹊疝气修补术，嵌顿性，－无肠切除鼠蹊疝气修补术，复发性，－无肠切除股疝气修补术－无肠切除腰椎疝气修补术Repair of lumbar hernia腹腔镜疝气修补术Herniorraphy腹腔内脓疡引流术治疗急性穿孔性腹膜炎Drainage of intraabdominal abscess for acute perforation peritonitis膈下脓疡引流术Drainage of subphrenic abscess骨盆腔脓疡引流术－经腹Drainage of pelvic abscess——transabdominal骨盆腔脓疡引流术－经肛门Drainage of pelvic abscess——transanal剖腹探查术Exploratory laparotomy 腹腔良性肿瘤切除术Excision of intraabdominal tumor，benign后腹腔良性肿瘤切除术Excision of retroperitoneal tumor，benign腹腔内异物却除术Removal of intraabdominal foreign body后腹腔剖腹探查术Retroperitoneal exploratory laparotomy腹腔恶性肿瘤切除术Excision of intraabdominal tumor，malignant后腹腔恶性肿瘤切除术并后腹腔淋巴腺摘除术Excision of retroperitoneal tumor，malignant with retroperitoneallymphadenectomy腹腔静脉分流术Peritoneo-Venous shunt脐尿管或瘘管切除术与部分胆囊切除术Excision of Urachal duct or fistula withpartial cholecystectomy腹壁损伤修复术－简单Repair of abdominal wall injury——simple with/without reconstruction腹壁损伤修复术－广泛性Repair of abdominal wall injury——extensive with reconstruction or prosthesis腹壁缝合裂开剜脏术，第二次缝合Suture of abdominal wall for evisceration ofdehiscence for secondary closure。
肛周间隙解剖新进展
肛 裂
手 术 内
括 约 肌
部 分 切
断
内括约肌能否完全切断？
联合纵肌
联合纵肌
联合纵肌的功能
• 将肛门直肠与骨盆连接，作为一个骨架支 撑并将内外括约肌综合体结合在一起。
联合纵肌的功能
• Parks1961年提出：括约肌间隙脓肿为腺源 性肛周感染的原发灶，脓肿沿括约肌间隙 内联合纵肌纤维隔的延伸方向向肛周其他 组织间隙播散，最终形成不同类型的慢性 感染性瘘管。
Second Ed ition
Ed itors
David E. Beck, M D, FACS. FASCRS Patricia L. Roberts, MD. FACS. FASCRS Theodore J. Saclarides. MD. FACS, FASCRS A ntho ny J. Senagore, M D. FACS, FASCR Michael J. Stamos, MD. FACS, FASCRS St巳ven 0 . Wexner. MD. FACS. FASCRS. FRCS. FRCS(Ed)
肛腺的解剖位置
• 腺源性感染理论
• anatomy.mpg
Parks 1976
• 肛腺平均6个（3-12），多集中在后半象限 ，2/3肛腺进入内括约肌，其中一半终止于 括约肌间沟。
•
申山大 串 附 属 第 六 医 院 广东省 胃肠缸 门医 院
The ASCRS Textbook of Colon and Rectal Surgery
程库提出7 更高的要求．但是2 仔细阅读国内外商关直肠手术解 自l字 、直脏手术学权副教科书和中莫文专著
时却发现F 许多与手．配·
音看合主
肛瘘手术治疗新进展
肛瘘手术治疗新进展覃杰;张森【期刊名称】《结直肠肛门外科》【年(卷),期】2015(021)006【总页数】5页(P472-476)【作者】覃杰;张森【作者单位】广西医科大学第一附属医院结直肠肛门外科广西南宁 530022;广西医科大学第一附属医院结直肠肛门外科广西南宁 530022【正文语种】中文肛瘘是直肠或肛管与肛周皮肤相通的肉芽肿性通道，由内口、外口及窦道组成，是肛门周围间隙感染的慢性阶段。
国际上常用的肛瘘分类方式为高位肛瘘和低位肛瘘分类方式（瘘管通过肛门外括约肌的下 1／3 称为低位肛瘘）以及 Park 分类方式［1］（即：A.括约肌间瘘；B.经括约肌肛瘘；C.括约肌上方肛瘘；D.括约肌外侧肛瘘）。
肛瘘治疗首选手术，传统术式治疗低位肛瘘以瘘管切开术、瘘管切除术为主，治疗高位肛瘘则以切开挂线术为主。
传统手术治疗肛瘘仍是十分有效的。
如：国外有报道传统瘘管切除术治疗低位肛瘘病人Kaplan－Meier曲线 5 年治愈率为 81%［2］。
术后出现排便控制不佳，甚至导致肛门失禁是多方面原因共同引起的，尽管传统手术术后出现肛门失禁的情况是很低的（＜10%）［3］，但在讲究医疗质量的当代，人们迫切需要更好的治疗方式。
理想的肛瘘治疗目标是实现肛瘘愈合及肛门功能形态正常相统一。
为此，近年来国内外出现了许多肛瘘微创治疗的探索，诸如Lift（The Ligation of Intersphincteric Fistula Tract），改良 Lift（bioLift、Lift plu），肛瘘栓填塞术（Anal Fistula Plug，简称 AFP）视频辅助治疗肛瘘法（Video－assisted anal fistula treatment，简称VAAFT），脂肪源性干细胞治疗肛瘘法（adipose－derived stem cells for the treatment of anal fistula，简称ASCs）等治疗方法。
肛肠科常用疾病名称中英对照
radiation colitis
结直肠黑变病 melanosis coli，MC
肛周湿疹 anal eczema
家族性腺瘤性息肉病 familial adenomatous polyposis，FAP
便秘 constipation
慢传输型便秘 slow transit constipation，STC
骶前囊肿 presalral cyst
直肠阴道瘘 rectovaginal fistula ，RVF
肛管直肠损伤 anorectal injury
直肠异物 foreign body in the rectum
耻骨直肠肌肥厚症 puborectalis ctalismuscle hypertrophy，PRMH
耻骨直肠肌综合征 puborectalis syndrome，PRS
会阴下降综合征 descending perineum syndrome，DPS
肛瘘 anal fistula
单纯性肛瘘 simple anal fistula
复杂性肛瘘 complex anal fistula
低位肛瘘 low anal fistula
先天性巨结肠症 congenital megacolon
先天性肛管直肠畸形 congenital ano-rectal malformation
直肠癌 cancer of rectum
直肠类癌 carcinoid of rectum
肛门直肠周围脓肿 perianal and perirectal abscesses
坐骨直肠间隙脓肿 ischiorectal abscess
骨盆直肠窝脓肿 pelvi-rectal abscess
保留括约肌瘘管潜剥术治疗复杂性肛瘘的疗效观察
浙江临床医学2021年5月第23卷第5期•697••诊治分析•保留括约肌瘘管潜剥术治疗复杂性肛瘘的疗效观察洪中华陈会林钦梦婷陈宏美王启尹和宅*【摘要】目的观察保留括约肌瘘管潜剥术治疗复杂性肛瘘的疗效方法复杂性肛瘘患者97例，随机分为观察组（49例，保留括约肌瘘管潜剥术）和对照组（48例，肛瘘低位切幵高位挂线术）。
比较两组手术时间、创面愈合时间、复发及肛门功能，手术前、后肛管静息压及最大收缩压变化，术后疼痛评分。
结果两组手术时间比较差异无统计学意义（P<0.05 )，观察组创面愈合时间为（28.58±4.25 ) d，优 于对照组（31.37±7.10)d，差异有统计学意义（P<0.05)，观察组术后出现肛门功能变化及复发例数分别1例、2例，低于对照组7例、8例，有统计学差异；观察组术后平均肛门静息压和随访3个月后肛门最大收缩压分别为（71.4±8.1)m m H g、（106.5±9.6)m m H g，对照组分别 (65.6±7.4)m m H g、（101.8±11.4)m m H g，两组比较差异有统计学意义，且对照组前、后组内压力比较差异有统计学意义（P<0.05);观 察组术后第3d、7d静息状态下疼痛评分分别为（2.10±0.61)、（1.23±1.24)，均低于对照组的（2_50±0.84)、（1.8±0.12)，差异有统计学意义（P<〇.〇5)。
结论保留括约肌瘘管潜剥术治疗复杂性肛瘘疗效满意，符合微创理念，值得临床推广。
【关键词】复杂性肛瘘保留括约肌瘘管潜剥术肛瘘切开挂线术【A bstract 】Objective To compare the outcomes o f anal sphincter—preserving bareness and cutting seton in complex anal fistula. Methods Ninety—seven patients with complex anal fistula were randomly divided into observation group ( 49 patients with sphincter-preserving fistula bareness) and control group ( 48 patients with anal fistulae with low incision and high cutting seton ) .The operation time, wound healing time, recurrence and anal function, changes in anal canal resting pressure and maximum systolic pressure before and after surgery, and postoperative pain scores were comparatively studied. Results All operations were performed successfully. There was no statistically significant difference ( P<0.05 ) betAveen the two groups in terms of operation tim e, and the time of wound healing in the observation group was ( 28.58 ± 4.25 ) d，which was better than that in the control group ( 31.37 ±7.10 ) d. The number o f cases of postoperative anal function changes and recurrence in the observation group were 1and 2 cases, respectively, which were lower than that in the control group ( 7 and 8 cases ) , and there was a statistical difference. The mean postoperative anal resting pressure and the maximum anal systolic pressure after 3 months o f follow—up were ( 71.4 ±8.1 ) rnniHg and (106.5 ±9.6 ) mmHg in the observation group and ( 65.6 ± 7.4 ) mmHg and ( 101.8 ± 11.4 ) mmHg in the control group, respectively, and the differences between the two groups were statistically significant, and the differences betAveen the pre—group and post—group pressure in the control group were statistically ( P<0.05 ) ; the pain scores at resting state in the observation group were ( 2.10 ± 0.61 ) and ( 1.23 ± 1.24 ) in the 3d and 7d postoperative periods, respectively, which were lower than those in the control group ( 2.50 ± 0.84 ) and ( 1.8 ± 0• 12 )，and the differences were statistically significant ( P<0.05 ) . Conclusion The sphincter—preserving fistula bareness procedure for complex anal fistula has satisfactory efficacy and is in line with the minimally invasive concept, which is worthy of clinical promotion.【Key w o rd s 】Complex anal fistula Sphincter-preserving fistula Fistula bareness Cutting seton肛瘘是肛周常见感染性疾病之一，发病率达l〇~21/ 万人,男性是女性发病率的2~6倍,多发于30~40岁[11。
肛瘘微创治疗新进展
肛痿微创治疗新进展李天煜1，2，廖日煜2,蔡伟杰猿(1.广东医科大学外科学教研室，广东东莞523808；2.广东医科大学附属医院胃肠外科，广东湛江524001；3.中山大学附属第六医院胃肠外科，广东广州510655):专家介绍］李天煜，教授，主任医师，医学博士，硕士研究生导师，教学督导，学科带头人。
挂职新疆生产建设兵团七师卫计局副局长、七师医院副院长。
兼任全国中医药高等教育学会临床教育研究会肛肠分会常委，中华中医药学会肛肠专业委员会委员，中国医药教育协会肛肠专业委员会常委，中国抗癌协会会员，广东省中医药学会肛肠专业委员会常委，广东省保健协会肛肠分会副主任委员，东莞市中医学会肛肠专业委员会副主任委员，东莞市医学会结直肠肛门专业委员会委员，东莞市医疗事故鉴定专家。
科研方向为结直肠癌的早期诊断及综合治疗，肿瘤的分子生物学及表观遗传学研究。
主持20余项各级科研课题，发表论文50余篇。
揖摘要】肛痿是肛管直肠与肛周皮肤间存在的一种慢性炎症的上皮化异常通道，为一种常见的难治性良性疾病，不彻底治疗有恶变倾向。
手术是目前主要的治疗方法，微创是当前肛痿手术趋势。
该文对肛痿治疗微创新方法包括肛痿实虚挂线术、括约肌间痿管结扎术、直肠黏膜瓣推移术、生物蛋白胶封堵及肛痿栓等方法进行综述，以期对肛痿治疗起引导作用。
揖关键词】肛痿;微创治疗;进展中图分类号:R657.1垣6文献标志码：A DOI：10.3969/j.issn.1003-1383.2021.01.002New progress in minimally invasive treatment of anal fistulaLI Tianyu12,LIAO Riyu2,CAI Weijie3(1.Teaching and Research Section of Surgery,Guangdong Medical University,Dongguan523808,Guangdong,China；2.D epartment of Gastrointestinal Surgery,Affiliated Hospital of Guangdong Medical University,Zhanjiang524001,Guangdong,China；3.Department of Gastrointestinal Surgery,The Sixth Affiliated Hospital of Sun Yat-sen University,Guangzhou510655,Guangdong,China)揖Abstract］Anal fistula is an abnormal epithelialization channel of chronic inflammation between anorectal and perianal skin.It isa common incurable benign disease with a tendency of malignant transformation if it is not treated thoroughly.Surgery is the main treatment at present,minimally invasive is the current trend of anal fistula.In order to guide the treatment of anal fistula,this paper reviews the new minimally invasive methods of anal fistula treatment,including anorectal hypertrophy hanging,ligation of intersphincteric fistula tract,rectal mucosal flap eluviation,biological protein glue plugging and anal supposal,etc.揖Key words］anal fistula；minimally invasive treatment；progress肛痿是肛管直肠与肛周皮肤间存在的一种慢性炎症的上皮化异常通道,多由隐窝源性肛腺感染后基金项目：东莞市社会科技发展项目(2017507152461)作者简介:李天煜，男,医学博士，教授,主任医师，硕士研究生导师,研究方向:结直肠癌基础与临床研究遥E-mail：437565935@［本文引用格式］李天煜，廖日煜，蔡伟杰.肛痿微创治疗新进展［J］.右江医学，2021，49(1)：7-11.所致。
LIFT与切开挂线术治疗复杂性肛瘘的疗效评价
LIFT与切开挂线术治疗复杂性肛瘘的疗效评价1. 引言1.1 疾病背景肛瘘是一种常见的肛门疾病，通常是由于肛管周围的感染或炎症导致肛管周围组织形成窦道，从而形成病变。
肛瘘通常会导致肛门疼痛、排便困难、局部感染等症状，严重影响患者的生活质量。
复杂性肛瘘是指伴有多个窦道或者与肛管周围重要器官（如括约肌）相连接的肛瘘，治疗起来更加具有挑战性。
针对复杂性肛瘘的治疗方法，各种疗效评价指标的研究逐渐成为学术研究的热点。
本文通过对LIFT和切开挂线术在治疗复杂性肛瘘中的疗效进行评价，旨在为临床医生提供更为科学的治疗方案，提高患者的治疗效果和生活质量。
1.2 治疗方法介绍肛瘘是指肛门周围的感染性疾病，主要由肛门周围的感染蔓延至肛管形成。
肛瘘的治疗方法有多种，其中比较常见的有LIFT（ligation of intersphincteric fistula tract）和切开挂线术。
LIFT 是一种相对较新的治疗方法，通过在括约肌内切开瘘道，然后将其结扎闭合来治疗肛瘘。
而切开挂线术是传统的治疗方法，通过在瘘道周围置入吸收性线带，来促进愈合和排脓。
这两种治疗方法各有优缺点，因此需要进行疗效评价来确定哪种方法更适合治疗复杂性肛瘘。
研究对比不同治疗方法的效果，可以帮助医生选择最合适的治疗方案，提高治疗成功率。
本研究旨在通过对LIFT与切开挂线术治疗复杂性肛瘘的疗效评价，为临床医生提供参考，提高治疗效果。
1.3 研究目的本研究的目的是评价LIFT与切开挂线术治疗复杂性肛瘘的疗效，并比较两种方法的优劣。
通过对这两种手术方法的效果进行分析和比较，旨在为临床医生提供更科学的治疗方案选择，提高治疗效果和患者生活质量。
具体来说，本研究将评估LIFT和切开挂线术在术后恢复情况、并发症发生率、术后疼痛程度、术后排便功能等方面的差异，以期为临床决策提供可靠的依据。
通过本研究的深入分析，我们可以更全面地了解这两种手术方法在治疗复杂性肛瘘中的实际效果，为医学实践提供更科学和准确的指导。
肛裂手术方案
肛裂手术方案肛裂是指肛门周围出现一道病理性裂口，非常疼痛且严重影响患者的生活质量。
针对肛裂疾病，医生通常会给出不同的手术方案。
本文将从传统手术到现代微创手术，介绍几种常见的肛裂手术方案。
一、传统手术（Milligan-Morgan手术）Milligan-Morgan手术是最常见的肛裂手术方案之一。
该手术通过切除病变处皮肤和黏膜，将肌肉纤维暴露，进而缝合裂口。
传统手术的优点是疗效稳定，但缺点是术后疼痛明显，恢复时间较长。
二、闭合肌肉松解术（Ferguson手术）闭合肌肉松解术，也被称为Ferguson手术，是一种改良的传统手术方案。
与Milligan-Morgan手术不同的是，闭合肌肉松解术通过松解肌肉，减少对肛门括约肌的张力，从而改善肛门疼痛。
这种手术的优点是术后疼痛较传统手术稍轻，恢复时间相对较短。
三、括约肌侧裂术（Lateral Internal Sphincterotomy，LIS）括约肌侧裂术（LIS）被广泛应用于治疗肛裂症患者，特别是慢性肛裂患者。
该手术通过切除肛门括约肌的一部分，改善肛门括约肌痉挛和肛门括约肌对裂口的牵引作用。
LIS手术的疗效显著，但术后疼痛常常是患者关注的一个问题。
四、弹力结扎术（Ligation of the Intersphincteric Fistula Tract，LIFT）弹力结扎术，也称为LIFT手术，是一种相对较新的微创手术方案。
LIFT手术不同于传统手术，它不需要切口，减少了创伤和术后疼痛。
这种手术通过结扎并切断直肠周围的瘘管，促进愈合。
LIFT手术的优点是术后疼痛轻，恢复时间相对快。
五、LIFT与Botox结合（Botox + LIFT）近年来，一种新的肛裂手术方案逐渐被广泛采用。
这种方案将弹力结扎术与Botox注射相结合，旨在更好地改善肛门疼痛。
Botox能够松弛肛门括约肌，减轻术后疼痛和括约肌痉挛，进而促进愈合。
Botox + LIFT手术方案不仅疗效显著，而且术后疼痛较轻，恢复时间相对较短。
手术(operation_procedure)名称翻译全集之三
手术（operation/procedure）名称翻译全集之三虾蟆肿切开术Incision of ranula虾蟆肿切除术Excision of ranula舌部份／楔状切除术Partial/wedge glossectomy舌修补术Repair of tongue injury or wound颚扁桃摘出术Resection of Platine tonsil舌扁桃切除术Lingual tonsillectomy咽扁桃切除术Adenoid tonsillectomy冷冻扁桃腺手术Cryotherapy for tonsillar深颈部切开引流术Deep neck incision & drainage下颔腺切除术Ablation of submaxillary gland口腔黏膜切片Biopsy of oral mucosa口腔或口咽肿瘤切除，并颈淋巴腺根除术Oral tumor or oropharynx excision with radical neck dissection舌癌摘出术，包括淋巴节切除及颈部清除术Tongue cancer excision with lymphadenectomy & radical neck dissection 舌骨上区清除术Suprahyoid dissection耳下腺肿瘤切除术Excision of parotid tumor舌半切除术Hemiglossectomy舌全切除术Total glossectomy内上颔动脉结扎Ligation of internal maxillary artery腮腺切除术，全叶摘除Parotidectomy，total lobectomy腮腺切除术，切除Parotidectomy，excision口腔底部整体切除术Commando op.口腔复合性切除术Composite resection for oral cancer食道肌切开术Esophageal myomectomy食道憩窒切除术Excision of esophageal diverticulum食道内腔置管术Endoesophageal intubation食道胃底改道术Esophagofundostomy bypass食道胃底吻合术Esophagofundostomy食道胃改道术Esophagogastrostomy bypass抗胃食道逆流术Blesy's mark iv anti-reflex procedure逆行食道扩张术Retrograde esophageal dilatation （esophagectasia，retrograde）食道、胃瘘管缝合术Esophagogastric fistula closure食道切除术Esophagectomy食道切除再造术Esophagectomy & reconstruction食道切开术Esophagotomy食道瘤及囊肿切除术Excision of esophageal cyst & tumor食道再造术——以胃管重建Esophageal reconstruction with gastric tube食道再造术——以大肠重建Esophageal reconstruction with colon食道再造术——以小肠重建Esophagel reconstruction with small intestine食道裂伤修补术Repair of esophageal laceration一般性食道癌摘除术（含淋巴节清扫）Simple excision of esophageal cancer，with lymphadenectomy复杂性食道癌摘除术（含淋巴节清扫）Complicated excision of esophageal cancer，with lymphadenectomy 食道静脉瘤曲张结扎，经胸或经腹Ligation of esophageal varices，transthoracic or transabdominal食道静脉瘤曲张结扎，脾脏切除并近心端胃血管去除－经胸Devascularization procedure——transthoracic食道静脉瘤曲张结扎，脾脏切除并近心端胃血管去除－经腹Devascularization procedure——transabdominal胃食道内管留置（胃贲门癌或食道癌）Esophagogastric stent for esophagus or cardia portion cancer胃切开术－探查性Gastrotomy——exploration胃切开术－异物移除Gastrotomy——removal of foreign body胃切开术－溃疡缝合及止血Gastrotomy——with suture repair of bleeding ulcer幽门肌肉切开术（Fredet-Ramstedt型手术）Pyloromyotomy，Fredet-Ramstedt胃溃疡或肿瘤的局部切除Local excision，ulcer or tumor胃全部切除术Gastrectomy，total & angreconstruction胃造瘘术及幽门成形术Gastrostomy & pyloroplasty次全或半胃切除术及胃十二指肠吻合术－无迷走神经切除Subtotal gastrectomy or hemigastrectomy with gastro-duodenostomy without vagotomy 次全或半胃切除术及胃空肠吻合术－无迷走神经切除Subtotal gastrectomy or hemigastrectomy with gastrojejunostomy without vagotomy次全或半胃切除术及胃空肠吻合术Roux-en-Y型－无迷走神经切除補英文次全或半胃切除术－伴有迷走神经切除Gastrectomy，subtotal or hemigastrectomy ——with vagotomy迷走神经切断术加幽门成形术V agotomy and pyloroplasty幽门成形术Pyloroplasty胃十二指肠造口吻合术Gastro-duodenostomy胃空肠造口吻合术Gastrojejunostomy胃小肠造口吻合术Gastroenterostomy胃空肠造口吻合术（伴有迷走神经切断术）Gastrojejunostomy with vagotomy胃造口术——暂时性Gastrostomy （plastic tube）十二指肠缝合术（十二指肠溃疡穿孔的缝合）Duodenorrhpahy，suture of perforated ulcer胃缝合术（胃溃疡穿孔及胃部伤口的缝合）Gastrorrhaphy，suture or repair wound，injury perforated ulcer of stomach 胃十二指肠造口再修正并或不并迷走神经切除Revision of gastroduodenostomy with or without vagotomy 胃切除后因出血而再剖开Re-exploration for postgastrectomy bleeding胃造口闭口Closure of gastrostomy十二指肠造口术Duodenostomy十二指肠肿瘤切除Excision of duodenum tumor十二指肠憩室切除或内翻Excision or inversion of duodenal diverticulum十二指肠瘘管闭合Closure of duodenal fistula十二指肠阻塞Duodenal obstruction高度选择性迷走神经切断术Highly selective vagotomy迷走神经切断术V agotomy胃贲门及食道切除再造术Proximal gastrectomy & esophagectomy & reconstruction 胃全部切除术并行脾或部份胰切除Gastrectomy，total，with splenectomy or partital pancreatectomy全胃切除及淋巴清除及肠胃重建Total gastrectomy，with LN dissection，with reconstruction （any type）95% 胃切除及淋巴清除及肠胃重建次全胃切除及淋巴清除及肠胃重建胃空肠造口再修正Revision of gastrojejunostomy残留胃窦切除术Resection of retained antrum，postgastrectomy胃隔间手术-垂直及圈带式胃整型术Gastric partition，vertical banded gastroplasty经十二指肠括约肌成形术Transduodenal sphinteroplasty胃折迭术Plication of stomach胃固定术（胃扭结）Gastropexy for gastric volvulus消化道华达壶腹切开术EPT （endoscopic papillectomy）腹腔镜胃隔间手术Laparoscopic gastric partition肠粘连分离术Enterolysis，freeing adhesion肠粘连分离术－并行肠减压Enterolysis——with bowel decompression肠粘连分离术－并有肠切除及吻合Enterolysis——with resection & anastomosis of intestine肠外置术（Mikulicz切除）Exteriorization of intestine，Mikulicz resection肠套迭之还原Reduction of intussusception肠套迭还原及肠切除和吻合Reduction of intussusception with bowel resection & anastomosis 肠套迭还原及肠造口或结肠造口Reduction of intussusception with enterostomy or colostomy良性肠病灶切除术Excision，Benign bowel lesion迈克氏憩室切除术Meckel's diverticulectomy小肠切除术加吻合术Resection of small bowel，with anastomosis结肠部分切除术加吻合术Colectomy，partial，with anastomosis根治性半结肠切除术加吻合术，升结肠Colectomy，radical hemicolectomy with anastomosis，ascending colon降结肠或乙状结肠切除术加吻合术Left hemicolectomy or sigmoid colectomy降结肠或乙状结肠切除术并行吻合术及淋巴节清扫Left hemicolectomy or sigmoid colectomy with anastomosis with lymph node结肠全切或次全切除术Colectomy，total or subtotal结肠全切除术并行直肠切除术及回肠造口Colectomy，total with proctectomy，with ileostomy单纯性结肠造口或肠造口矫正Revision of colostomy or enterostomy simple ，superficial.复杂性（进入腹腔）结肠造口或肠造口矫正Revision of colostomy or enterostomy complicated，deep.肠反逆流合术Antireflex produce in the intestine蹄形小肠或结肠造瘘管关闭Closure of enterostomy or Colostomy （loop or double-barrel ）肠造口术（包括结肠、空肠、永久性小肠）Enterostomy （including colostomy 、Jujunostomy、permanent enterostomy）小肠瘘管关闭术－小肠与皮肤Closure of intestinal fistula——Enterocutaneous小肠瘘管关闭术－小肠与结肠（或与小肠）Closure of intestinal fistula——entero-colic or entero-entero小肠瘘管关闭术－其它器官或包括合并症Closure of intestinal fistula——fistula of bowel with other organs or complicated 结肠瘘管关闭术－结肠与皮肤Closure of colon fistula——colocutaneous结肠瘘管关闭术－胃与结肠（不包括胃切除）Closure of colon fistula——gastroclic without gastrectomy结肠瘘管关闭术－胃与结肠（包括胃切除）Closure of colon fistula——gastroclic with gastrectomy结肠瘘管关闭术－结肠与其它器官或合并症Closure of colon fistula——fistula of colon with other organs or complicated肠吻合术－小肠与小肠（十二指肠）吻合术Anastomosis of bowel——entero-enterostomy or duodeno-enterostomy肠吻合术－回肠与结肠吻合术，有间路法Anastomosis of bowel——Anastomosis of bowel，ileo-colostomy，with bypass 肠吻合术－由小肠闭锁或狭窄引起Anastomosis of bowel——for intestinal atresia or stenosis小肠穿孔缝补术Repair of intestinal perforation肠系膜之缝合及修补Suture and repair of mesentery小肠瘜肉切除术Resection of intestinal polyp小肠折瘘术Intestinal plication，Noble type管肠造口或管盲肠造口Tube enterostomy or tube cecostomy肠吻合处切除，吻合重建术Take down of anastomosis，revision of ileo-colostomy and reconstruction回肠尿液引流袋修正术Revision of ileasl conduit经由剖腹术行小肠或结肠造瘘管关闭及吻合Closure of enterostomy or colostomy anastomosis ，by laparotomy阑尾脓疡之引流Drainage of appendiceal abscess transabdominal阑尾切除术Appendectomy阑尾瘘管关闭Closure of appendiceal fistula单纯性直肠周围脓疡之切开引流Incision and drainage for perirectal or perianal abscess复杂性直肠周围脓疡之切开引流（包括福尼尔氏肌膜炎坏死）Incision and drainage for Complicated perirectal abscess（ischiorectal，high intersphincteric，deep postanal，supralevator abscess ，Fournier's gangrene）直肠活体组织切片Rectal incisional biopsy直肠裂伤或损伤之修补Repair of rectal laceration or injury直肠固定术Thiersh or Delorme，Rectopexy by stitches fixation根治性直肠切除术（含骨盆腔淋巴腺切除术）Radical protectomy with pelvic lymph node dissectionHartmann 氏直肠手术Harmann operation经直肠大肠息肉切除术Transrectal colonic Polypectomy直肠脱出根治手术（经会阴接近及吻合）Rectal procidentia，perineal approach ，with resection& anastomosis 直肠脱出手术（腹部接近）Rectal procidentia，abdominal approach荐骨与尾骨肿瘤切除，良性Excision，sacrococcygeal tumor，benign直肠上皮绒毛腺肿广泛性切除术或癌症局部切除Extensive excision of sacrococcygeal rectal villous adenoma or malignancy 直肠狭窄整形术Rectoplasty for stricture or stenosis复原性直肠切除以及直肠、肛门吻合术Restorative proctectomy with colo-anal anastomosis复原性大肠直肠切除回肠储存袋以及回肠肛门吻合术Restorative proctocolectomy，pelvic ileal pouch with ileoanal anastomosis直肠膀胱瘘管切除术Closure fistula，reco-vesical直肠癌腹部会阴联合切除术Combined abdomino perineal resection for rectal cancer乙状结肠及直肠切除后Pull through 方法行直肠肛门吻合术Proctosigmoidectomy with pull through colon anal anastomosis乙状结肠及直肠切除后Pull through 方法行结肠造袋及结肠袋肛门吻合术Proctosigmoidectomy with pull through colon anal anastomosis，reconstruction with colonic pouch经尾骨由直肠后部切开行良性病灶切除方法Posterior proctotomy，transacrococcygeal excision of benign lesion.经尾骨由直肠后部切开行直肠癌切除方法Posterior proctotomy，transacrococcygeal resection of malignant tumor皮下瘘管切开术或切除术Fistulotomy or fistulectomy，simple，subcutaneous肛门括约肌切开术Sphincterotomy ，anal肛门裂缝切除术或溃疡切除术fissurectomy or ulcerectomy，anal隐窝切除术－单一Cryptectomy——single隐窝切除术－多数Cryptectomy——multiple外痔完全切除术Hemorrhoidectomy，external内外痔部份切除术Hemorrhoidectomy，partial，internal & external肛门乳突切除术－单一Papillectomy anal——single肛门乳突切除术－多数Papillectomy anal——multiple内外痔完全切除术Hemorrhoidectomy，internal & external肛门瘘切除或切开术并痔疮切除Anal fistulectomy or fistulotomy with hemorrhoidectomy 外痔血栓切除Thrombectomy，external hemorrhoid肛门狭窄整形术Anoplasty for stricture or imperforate肛门括约肌失禁整形术Sphincteroplasty for anal incontinenceAPR术后Karlex海棉除去术Removal of Karlex sponge s/p APR结肠肛门止血术Check anal or colon bleeding内痔结扎Internal hemorrhoid ligation肛门重建或整形术以S形蒂状移植Anal reconstruction or anoplasty with S-pedicle graft提肛肌折迭术Levator plication procedure复杂性皮下瘘管切开术或切除术Fistulotomy or fistulectomy，complicated，subcutaneous 楔状活体切片（剖腹探查术）Wedge biopsy of liver，laparotomy肝部分切除术Partial hepatectomy肝区域切除术－一区域Segemental hepatectomy ——one segement肝区域切除术－二区域Segemental hepatectomy ——two segements肝区域切除术－三区域Segemental hepatectomy——three segements肝囊肿或肝脓疡引流或造袋术Drainage or marsupialization of cyst or abscess of liver缝肝术（肝损伤缝合，小于5公分）Hepatorrhaphy，suture of liver wound < 5cm缝肝术及总胆管或胆囊之引流术Hepatorrhaphy，with common duct or gallbladder drainage 缝肝术（复杂肝损伤之缝合或大于5公分）Hepatorrhaphy，suture of liver wound，complicated or >5cm 肝动脉结扎Hepatic artery ligation for liver bleeding肝肠吻合Hepato-Enterostomy （Longmire Op.）肝门静脉分流术Portocavo shunt （H-graft）Warren氏分流术Warren's shunt右肝叶切除术Total right lobectomy左肝叶切除术Total left lobectomy扩大右肝叶切除术Extended right lobectomy扩大左肝叶切除术Extended left lobectomy切肝取石术Hepaticotomy or hepaticostomy，Removal of Calculus 肝脏移植Liver（Hepatic）transplantation尸体捐肝摘取Cadaveric liver harvest（donor hepatectomy）活体捐肝摘取Partial hepatectomy for livingrelated liver transplantation 胆囊造瘘术Cholecystostomy胆管截石术（经十二指肠）Cholecystolithotomy （transduodenal）胆囊切除术Cholecystectomy胆囊切除术及术中胆管摄影Cholecystectomy and cholangiography腹腔镜胆囊切除术Laparoscopic cholecystectomy总胆管空肠吻合术CholedochojejunostomyROUX-EN-Y总肝管肠吻合术ROUX-EN-Yhepaticojejunostomy胆囊消化管吻合术Cholecystoenterostomy总胆管全切除术Total excision of common bile duct总胆管切开及T形管引流Choledochotomy with T-tube drainage总胆管切开摘石术及T形管引流Choledocholithotomy with T-tube drainage胆管成形术Choledochoplasty胆道组织检查切片术Biopsy of biliary tract总胆管十二指肠吻合术Choledochoduodenostomy肝外胆管成形术Plasty of extrahepatic bile duct肝瘘管缝合术Closure of biliary fistula胰脏脓疡或胰炎引流术Drainage of pancreatic abscess or cyst or pancreatitis胰组织检查切片Pancreas incisional biopsy胰脏肿瘤或囊肿切除或摘除术Excision or enucleation of pancreatic tumor or cyst胰脏尾端部分切除术Distal partial pancreatectomy胰脏尾端部分切除术-脾脏保留補英文胰脏体部分切除术Body partial pancreatectomy胰脏体部分切除术-脾脏保留補英文胰瘘切除术Pencreatic fistulectomy胰囊肿至肠胃道之内部直接引流吻合术Anastomosis of pancreatic cyst to GI tract direct internal drainage胰囊肿至肠胃道之Y型内部吻合术Anastomosis of pancreatic cyst to GI tract directinternal drainage （Roux-en-Y）胰脏结石去除术Removal pancreatic calculus胰脏次全切除术Pancreatectomy subtotal胰脏全切除术Total pancreatectomy （95%）Whipple 氏胰、十二指肠切除术Pancreatico-duodenectomy，Whipple type，with reconstructionWhipple 氏胰、十二指肠切除术幽门保留式Pancreatico-duodenectomy，Whipple type，with reconstruction （pylorus sparing whipple op）胰脏空肠吻合术Pancreatico-Jejunostomy胰囊肿造袋术Marsupialization of pancreatic cyst腹壁脓疡引流术Drainage of abdominal wall abscess腹腔脓疡灌洗腹壁肿瘤切除术－良性Excision of abdominal wall tumor——benign腹壁肿瘤切除术－恶性Excision of abdominal wall tumor——malignant腹壁疝气修补术－并肠切除Repair of ventral hernia ——with bowel resection腹壁疝气修补术－无肠切除Repair of ventral hernia ——without bowel resection腹壁疝气修补术，嵌顿性，－无肠切除腹壁疝气修补术，复发性－无肠切除鼠蹊疝气修补术－并肠切除Repair of inguinal hernia ——with bowel resection鼠蹊疝气修补术－无肠切除Repair of inguinal hernia ——without bowel resection鼠蹊疝气修补术，嵌顿性，－无肠切除鼠蹊疝气修补术，复发性，－无肠切除股疝气修补术－无肠切除腰椎疝气修补术Repair of lumbar hernia腹腔镜疝气修补术Herniorraphy腹腔内脓疡引流术治疗急性穿孔性腹膜炎Drainage of intraabdominal abscess for acute perforation peritonitis 膈下脓疡引流术Drainage of subphrenic abscess骨盆腔脓疡引流术－经腹Drainage of pelvic abscess ——transabdominal骨盆腔脓疡引流术－经肛门Drainage of pelvic abscess ——transanal剖腹探查术Exploratory laparotomy腹腔良性肿瘤切除术Excision of intraabdominal tumor，benign后腹腔良性肿瘤切除术Excision of retroperitoneal tumor，benign腹腔内异物却除术Removal of intraabdominal foreign body后腹腔剖腹探查术Retroperitoneal exploratory laparotomy腹腔恶性肿瘤切除术Excision of intraabdominal tumor，malignant后腹腔恶性肿瘤切除术并后腹腔淋巴腺摘除术Excision of retroperitoneal tumor，malignant with retroperitoneal lymphadenectomy 腹腔静脉分流术Peritoneo-V enous shunt脐尿管或瘘管切除术与部分胆囊切除术Excision of Urachal duct or fistula with partial cholecystectomy腹壁损伤修复术－简单Repair of abdominal wall injury——simple with/without reconstruction腹壁损伤修复术－广泛性Repair of abdominal wall injury——extensive with reconstruction or prosthesis腹壁缝合裂开剜脏术，第二次缝合Suture of abdominal wall for evisceration of dehiscence for secondary closure骨盆腔恶性肿瘤消灭术Debulking operation for pelvic cancer。
治疗肛瘘的新术式和临床选择策略
治疗肛瘘的新术式和临床选择策略发表时间：2014-03-18T14:36:08.810Z 来源：《河南中医》2013年4月第1期供稿作者：王炜邹世镇张科王健诚[导读] 肛瘘不能自愈，必须手术治疗。
手术治疗原则是将瘘管全部切开，必要时将瘘管周围瘢痕组织同时切除，使伤口自基底向上逐渐愈合。
王炜邹世镇张科王健诚（广西医科大学第四附属医院柳州市工人医院肛肠外科广西柳州545005）【关键词】肛瘘；治疗【中图分类号】R657 1+6【文献标识码】B【文章编号】1003-5028(2013)05-0281-01肛瘘（anal fistula，fistula-in-ano）是肛管直肠疾病中的常见病，约占总发病率的30％，临床表现为反复发作的肛周感染、破溃流脓，长期不愈的病人可以发展成肛周癌。
其治疗方法本文将不再赘述，现仅将近年来保留括约肌的肛瘘治疗的新术式及临床选择策略综述如下本文将不再赘述，现仅将近年来保留括约肌的肛瘘治疗的新术式及临床选择策略综述如下。
1肛瘘的治疗手术原则和要点肛瘘的治疗手术原则1 彻底切除感染的肛隐窝，肛腺和肛腺导管，即正确找到和处理好内口，这是防止今后复发的关键。
2 保护肛门括约肌和肛管直肠环，否则，易导致肛门失禁的后遗症，给患者带来新的痛苦。
3 用探针探查瘘道和内口时宜轻柔仔细，正确寻找到瘘道后彻底清除管壁内纤维组织、腐肉和坏死组织，绝对不能粗暴，用探针探出一条“假瘘道”，结果切除的是假瘘道，导致真实的瘘道得不到处理。
4 一般主张在肛瘘充分形成后（最好是肛门直肠周围脓肿破溃或切排后二至三个月），做一次性根治术，以减少病人的痛苦和复发率。
在急性脓肿期做根治切除术并非良策。
5 术后创面要保持引流通畅，避免假性和桥形愈合，以免复发。
但如何使肛门瘘得到彻底根治，有效降低术后的复发率，同时最大限度地保护肛门功能，一直是临床医生需解决的难点问题。
2肛门瘘管治疗手术的现状肛瘘不能自愈，必须手术治疗。
常见肛周疾病commonanorectal
Diagnosis and Treatment of Anorectal Abscess and Fistula-inAno
Anorectal Abscess Etiology
Cryptoglandular abscess
– Most common – Infection in the glands at the dentate line
Supralevator Abscess
Intersphincteric Abscess
Ischioanal Abscess Perianal Abscess
HORSESHOE ABSCESS
Supralevator Space Intersphincteric Space Ischioanal Space
Fistula-in-Ano
Definition
– abnormal connection between two epithelial surfaces.
Classification:
– Parks: Defines fistula by course of tract – Goodsall’s rule
Common Office Anorectal Problems
Sandra J. Beck, M.D., FACS, FASCRS
Associate Professor of Colon and Rectal Surgery University of Kentucky Medical Center
Abscess Classification
Four Types Based on Space Involved – Perianal - 19-54% Most – Intersphincteric - 20-40% Common – Ischioanal - 40-60% Rare – Supralevator 2% or less
地奥司明片联合射频痔疮治疗机治疗肛门疾病150例
地奥司明片联合射频痔疮治疗机治疗肛门疾病150例孙利;金昊【摘要】Objective To explore the clinical effect of Diosmin Tablets combined with the radar hemorrhoid therapy apparatus in treating anal disease. Methods 300 cases of anal disease were randomly divided into the observation group and the control group,150 Cases in each group. The observation group was treated with Diosmin Tablets combined with the radar hemorrhoid therapy apparatus,the control group was treated with the radar hemorrhoid therapy apparatus alone. Results The various indexes in the two groups were significantly improved( P ﹤ 0. 05);except the pain symptom,the other various indexes in the observation group were significantly superior to the control group( P ﹤ 0. 05);the disappearance time of symptoms in the observation group was shorter than that in the control group( P ﹤0. 05);the total effective rate in the observation group was 100. 00% ,which was significantly higher than 88. 67% in the control group with statistical difference( P ﹤ 0. 05). Conclusion Diosmin Tablets combined with the radar hemorrhoid therapy apparatus has definite effect and high safety in treating anal disease,which is worthy of clinical promotion.%目的：探讨地奥司明片联合射频痔疮治疗机治疗肛门疾病的临床疗效。
传统手术方式和改良LIFT术式治疗肛瘘的临床研究
传统手术方式和改良LIFT术式治疗肛瘘的临床研究目的比較传统手术方式与改良LIFT术式治疗肛瘘的临床疗效。
方法选取2011年1月～2015年1月本院收治的200例肛瘘患者作为研究对象，根据手术方式分为传统手术组和改良LIFT手术组，各100例。
传统手术组给予肛瘘切除术，改良LIFT组给予LIFT术式治疗，比较两组的术后疼痛持续时间、出血持续时间、切口愈合时间、肛门功能以及临床疗效。
结果改良LIFT组的治疗总有效率为98.0%，显著高于传统手术组的81.0%，差异有统计学意义（P＜0.05）。
改良LIFT组术后1、3、7 d的疼痛评分显著低于传统手术组，住院时间显著短于传统手术组，差异有统计学意义（P＜0.05）。
改良LIFT组的创面愈合时间显著短于传统手术组，术后1、2个月的FISI评分显著低于传统手术组，差异有统计学意义（P＜0.05）。
改良LIFT组术后的不良反应发生率为3.0%，显著低于传统手术组的12.0%，差异有统计学意义（P＜0.05）。
两组随访3～6个月，期间均无肛门狭窄变形、肛门缺损及肛门移位等后遗症。
结论与传统的肛瘘切除手术相比，改良LIFT手术能够提高临床疗效，缩短术后疼痛时间以及出血时间，促进切口愈合，降低术后复发率，值得临床推广应用。
[Abstract]Objective To compare the clinical effect of traditional method and modified LIFT procedure in the treatment of anal fistula.Methods 200 patients with anal fistula from January 2011 to January 2015 in our hospital were selected and divided into the traditional surgery group and the modified LIFT surgery group according to surgical method，100 cases in each group.The traditional surgery group was given anal fistula resection，and the modified LIFT surgery group was given LIFT procedure.The duration of postoperative pain，duration of bleeding，healing time of incision，anal function and clinical efficacy of the two groups was compared.Results The total effective rate of the modified LIFT surgery group was 98.0%，which was higher than 81.0% of the traditional surgery group，with significant difference （P＜0.05）.The pain score after operation at 1，3，7 days in the modified LIFT surgery group was lower than that in the traditional surgery group，hospital stay in the modified LIFT surgery group was shorter than that in the traditional surgery group，with significant difference （P＜0.05）.The healing time of incision in the modified LIFT surgery group was shorter than that in the traditional surgery group，the FISI score after operation at 1，2 months in the modified LIFT surgery group was lower than that in the traditional surgery group，with significant difference （P＜0.05）.The incidence rate of adverse reaction in the modified LIFT surgery group was 3.0%，which was lower than 12.0% of the traditional surgery group，with significant difference （P＜0.05）.The two groups were followed up for 6 to 3 months，there were no complications such as anal stenosis，anal defect and anal displacement.Conclusion Compared with the traditional anal fistula surgery，the modified LIFT surgery can improve the clinical curative effect，shorten postoperative pain and bleeding time，promote wound healing，reduce the recurrence rate，it is worthy of clinical promotion and application.[Key words]Anal fistula；Anal fistula surgery；Modified intersphincteric fistula ligation肛瘘是肛肠科常见的难治性疾病之一，治疗方法首选手术，但术后复发率高且易引发肛门失禁，故一直是肛瘘治疗中的难题[1-2]。
视频辅助治疗肛瘘的研究进展
视频辅助治疗肛瘘的研究进展周娇娇;李华山;李宇飞;祝子贝;张茜【期刊名称】《结直肠肛门外科》【年(卷),期】2017(023)004【总页数】4页(P561-564)【作者】周娇娇;李华山;李宇飞;祝子贝;张茜【作者单位】中国中医科学院广安门医院肛肠科北京 100053;中国中医科学院广安门医院肛肠科北京 100053;中国中医科学院广安门医院肛肠科北京 100053;石景山区中医医院肛肠科北京 100043;中国中医科学院广安门医院肛肠科北京100053【正文语种】中文【中图分类】R657.1肛瘘是直肠或肛管与肛周皮肤相通的肉芽肿性通道，由内口、外口及窦道组成，是肛门周围间隙感染的慢性阶段。
据统计，我国肛瘘发病率占肛肠疾病总发病率的1.67%～3.6%［1］，国外肛瘘患者约为8.6～10 人/10 万人［2］，以 25～34 岁的青年男性为主［3］。
肛瘘的病因学说主要是基于 Eisenhammer［4］及Parks［5］提出的肛腺感染学说，其应用最广泛的是Parks分类法，即依据瘘管与肛门括约肌的关系，分为括约肌间瘘、经括约肌瘘、括约肌上瘘及括约肌外瘘［6］，依据瘘管与肛门直肠环的相对位置，肛瘘尚可分为低位肛瘘和高位肛瘘［7］。
手术是治疗肛瘘的首选方案，其中，视频辅助治疗肛瘘（video-assistedanal fistula treatment，VAAFT）是保护肛门括约肌功能的一种新术式，2011年由意大利的 Meinero 与 Mori首次提出［8］，整个手术过程在肛瘘镜下进行，术者在直视下发现并处理内口、潜在的分支瘘管与脓腔，即在保护肛门括约肌功能前提下彻底清除感染灶及封闭内口，以期降低肛瘘复发率，具有手术创伤小、疼痛轻、住院时间短等特点。
本文将从VAAFT产生背景及应用现状进行综述。
治疗肛瘘的手术方法随时间迁移发生了改变。
Blumetti等［9］通过对 1975 年至2009 年间 2267 例具有代表性且观察时间长的肛瘘患者进行回顾性分析，发现在20世纪90年代之后接受括约肌保留术式的患者比例逐渐增加。
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ORIGINAL ARTICLEFactors affecting continence after fistulotomy for intersphincteric fistula-in-anoTakayuki Toyonaga&Makoto Matsushima&Takashi Kiriu&Nobuhito Sogawa&Hiroki Kanyama&Naomi Matsumura&Yasuhiro Shimojima&Tomoaki Hatakeyama&Yoshiaki Tanaka&Kazunori Suzuki&Masao TanakaAccepted:11January2007/Published online:30January2007#Springer-Verlag2007AbstractBackground and aims This study was undertaken to determine the incidence of and risk factors for anal incontinence after fistulotomy for intersphincteric fistula-in-ano.We also evaluated the role of anal manometry in preoperative assessment of intersphincteric fistula. Materials and methods A prospective,observational study was undertaken in148patients who underwent fistulotomy for intersphincteric fistula between January and December 2004.Functional results were assessed by standard ques-tionnaire and anal manometry.Possible factors predicting postoperative incontinence were examined by univariate and multivariate regression analyses.Results The mean follow-up period was12months.Post-operative anal incontinence occurred in30patients(20.3%), i.e.,soiling in6,incontinence for flatus in27,and incontinence for liquid stool in4.Fistulotomy significantly decreased maximum resting pressure(85.9±20.4to60.2±18.4mmHg,P<0.0001)and length of the high pressure zone(3.92±0.69to3.82±0.77cm,P=0.035),but it did not affect voluntary contraction pressure(164.7±85.2to160.3±84.8mmHg,P=0.2792).Multivariate analysis showed low voluntary contraction pressure and multiple previous drain-age surgeries to be independent risk factors for postoperative incontinence.Conclusion Fistulotomy produces a satisfactory outcome in terms of eradicating sepsis and preserving function in the vast majority of patients with intersphincteric fistula with intact sphincters.However,sphincter-preserving treatment may be advocated for patients with low preoperative voluntary contraction pressure or those who have undergone multiple drainage surgeries.Preoperative anal manometry is useful in determining the proper surgical procedure. Keywords Anal fistula.Intersphincteric fistula. Fistulotomy.Fecal incontinence.Anal manometryIntroductionThe aim of treatment for fistula-in-ano is to permanently eliminate abscess formation and achieve healing,while preserving anal function and continence.Fistulotomy successfully eliminates the fistula,but incontinence after fistulotomy has been reported in2–62%of patients[1–7]. Complaints of incontinence are often neglected by sur-geons,but incontinence is reported to dramatically influ-ence the quality of life and satisfaction of patients after fistula surgery[8,9].Several risk factors for postoperative incontinence have been suggested,including female sex[3, 6,7],previous fistula surgery[3,10],fistula type[3,6,9], posterior internal opening[2],high internal opening[2], fistula extension[2,9],low resting pressure[7],and the type of operative procedure[3].Int J Colorectal Dis(2007)22:1071–1075DOI10.1007/s00384-007-0277-zT.Toyonaga(*):M.Matsushima:T.Kiriu:N.Sogawa: H.Kanyama:N.Matsumura:Y.Shimojima:T.Hatakeyama: Y.Tanaka:K.SuzukiDepartment of Surgery,Matsushima Hospital Colo-Proctology Center,19-11Tobehoncho,Nishi-ku,Yokohama,Japane-mail:toyozo7@yahoo.co.jpM.TanakaDepartment of Surgery and Oncology,Graduate School of Medical Sciences,Kyushu University, Fukuoka,JapanBecause fistulotomy for a trans-sphincteric or more complicated fistula divides both the internal and external sphincters and results in an increased incidence of incon-tinence,non-sphincter splitting surgical procedures,such as core fistulectomy and closure of the internal opening with an advancement flap,have been advocated by many authors [11–16].It is also believed that fistulotomy for intersphinc-teric fistula divides only part of the internal sphincter and poses a low risk of postoperative incontinence.However, little is known about functional and manometric outcomes after fistulotomy for intersphincteric fistula.In this study,we investigated clinical and physiologic results,in terms of anal continence,after fistulotomy for intersphincteric fistula.We also evaluated the role of preoperative anal manometry in predicting postoperative continence disturbance.Materials and methodsPatientsWe prospectively examined functional and manometric results in275consecutive patients with chronic fistula who were treated at Matsushima Hospital Colo-Proctology Center during the period January through December2004. Our policy about surgical management of anal fistula was that when fistula was in acute phase and abscess formation was present,only incision drainage was performed. Curative operation,such as fistulotomy,was performed after abscess had disappeared and inflammation had been settled.The fistula in each case was finally classified at the time of curative surgery according to the criteria of Parks et al.[17].Classification of fistula was intersphinc-teric in191patients,trans-sphincteric in82,and supra-sphincteric in2.Surgical procedures were fistulotomy for 198patients(168with intersphincteric fistula,and30with trans-sphincteric fistula),cutting-seton fistulotomy in22 patients(12with intersphincteric fistula and10with trans-sphincteric fistula),and fistulectomy with an advancement flap for54patients(11with intersphincteric fistula,42 with trans-sphincteric fistula,and2with suprasphincteric fistula).In the present study,we investigated clinical and physiologic results after fistulotomy for intersphincteric fistula.To simplify the objective of our study,we excluded 20patients with multiple fistulas,11patients who underwent fistulectomy with an advancement flap,and12patients who underwent cutting-seton fistulotomy from191patients with intersphincteric fistula.Thus,a total of148patients(135 males and13females)who underwent fistulotomy for solitary intersphincteric fistula were the subjects of this study.Surgical proceduresPreoperative endoanal ultrasonography were performed in all the patients,and level of internal opening were classified as upper third(high),middle third(intermediate),and lower third(low)of the anal canal.All patients underwent mechanical bowel preparation and received antibiotic prophylaxis,and all were operated on in the prone jack-knife position under spinal anesthesia.A Parks retractor(or modified Parks retractor)was used to observe the anal canal.The operation consisted of localizing the internal opening and identifying the complete fistulous tract,and then laying it open,creating adequate drainage.After the primary and secondary fistula tracts were laid open, the wound was marsupialized.The anoderm and skin at the wound edges were sutured to the sides of the open fistula tract with interrupted or continuous stitches(2-0Vicryl, Ethicon,Norderstedt,Germany).All tissues excised from the area of the fistula were examined by a pathologist to rule out inflammatory bowel disease or cancer.Beginning on postoperative day1, patients were fed an ordinary diet and given bulk laxatives. Perianal cleansing was done with sitz baths after bowel movements.After discharge from the hospital,each patient visited the outpatient clinic for regular follow-up examina-tions,and clinical outcome was assessed by an independent observer for a period of at least6months after surgery. Routine follow-up was finished when the patient was full continent and symptom free in postoperative6months.But, if the patient complained of some degree of incontinence after6months,follow-up examination was continued and treatment with biofeedback training was performed.Recur-rence was defined as either discharge or an abscess arising in the same area or obvious evidence of fistula formation. Continence questionnaireAll patients were asked to complete a written questionnaire, pertaining to continence,twice,once before surgery and once6months after surgery.The degree and frequency of soiling and incontinence involving flatus,fluid,or solid stool was assessed and scored on a scale of0–20 (Cleveland Clinic Florida Incontinence Score)[18].Anal manometryAnal manometry was performed with a microtransducer connected to a GMMS-600pocket monitor(Star Medical, Tokyo,Japan)pre-and postoperatively(2months after surgery or when the surgical wound was completely healed).The patient was placed comfortably in the Sims position,and manometry was performed at rest and during voluntary contraction.No enema was given before theexamination.Maximal resting and squeeze pressures were recorded.V oluntary contraction pressure,i.e.,the difference between maximum resting pressure and maximum squeeze pressure,was taken as an index of external sphincter function.Length of the anal canal,i.e.,length of the high pressure zone at rest was also determined by the continuous pull-through method.Statistical analysisValues are shown as mean±standard deviation.Between-group differences in incontinence scores were analyzed by Mann–Whitney U test,one-way analysis of variance (ANOV A)or Spearman’s rank correlation coefficient.Differ-ences in incontinence scores and manometric values before and after surgery were analyzed by Wilcoxon’s matched-pair test and paired t test,respectively.Multivariate binary logistic regression analysis was used to identify independent predictors of incontinence after surgery.Statistical analyses were carried out with STATVIEW4.5software(Abacus Concepts,Berkley,CA).Differences were considered statis-tically significant at P<0.05.ResultsMean age was42.4years(range14–73years).Eighty-five patients had previously undergone anorectal abscess surgery. Of these patients,13had required two or more drainage surgeries because abscess formation had revived until fistulotomy was performed.Six patients had previously undergone fistula surgery at previous hospital.The mean duration of symptoms before surgery at our hospital was 11months(range1–122months).The location of the internal opening was anterior in19patients(13%),lateral in 26(18%),and posterior in103(70%).The level of internal opening was high in6patients(4%),intermediate in80 (54%),and low in62(42%).The mean follow-up period was12months(range6–24months).Histological examination revealed no inflam-matory bowel disease or cancer in any patient.No major complication occurred after surgery.Fistula recurred in four patients(2.7%).Additional surgical intervention was re-quired in these four patients(abscess drainage and resection of the residual secondary tract in two and abscess drainage and renewed fistulotomy in two).Postoperatively,118patients(79.7%)were fully conti-nent,and30patients(20.3%)complained of some degree of change in continency.Details are as follows:6patients reported staining their underclothing(two sometimes,two, usually and two always),27reported having difficulty holding gas(two rarely,seven sometimes,ten usually,and eight always)and4reported incontinence for liquid stools (three rarely and one usually).No patient was incontinent for solid stools.Postoperative incontinence scores were significantly higher than the preoperative scores[0.69±1.67 (range0–11)vs0.05±0.32(range0–2),P<0.0001].Manometric studies showed that maximum resting pres-sure was significantly decreased after fistulotomy(from 85.9±20.4to60.2±18.4mmHg,P<0.0001).V oluntary contraction pressure did not change substantially after fistulotomy(from164.7±85.2to160.3±84.8mmHg, P=0.2792).The length of the high pressure zone was significantly decreased after fistulotomy(from3.92±0.69 to3.82±0.77cm,P=0.035).Results of univariate analysis assessing factors affecting the postoperative incontinence score are shown in Table1. Age,sex,previous fistula surgery,previous drainage surgery, duration of symptoms,location and level of the internal opening,and operation time did not significantly influence the postoperative continence score.The preoperative maxi-mum resting pressure and anal canal length also did not affect the postoperative incontinence score.Only preopera-tive voluntary contraction pressure correlated significantly with the postoperative incontinence score.Multivariate analysis showed that low voluntary contraction pressure (odds ratio=2.716,95%CI=1.107–6.666,P=0.0291)and multiple previous drainage surgeries(odds ratio=1.971,95% CI=1.013–3.834,P=0.0457)are independent risk factors for impaired continence(Table2).DiscussionFecal continence is maintained partly by voluntary contrac-tion of the striated muscle fibers of the external sphincter and of the levator ani,and partly,by involuntary tone of the smooth muscle fibers of the internal sphincter.Fistulotomy for intersphincteric fistula divides only part of the internal sphincter and does not scarify the external sphincter. Accordingly,maximum resting pressure and functional anal canal length decreased significantly after fistulotomy in our series of patients,but voluntary contraction pressure was not affected.Therefore,the decrease in continence we observed after fistulotomy for intersphincteric fistula seemed to be associated with impaired internal sphincter function and deformity of the anal canal.We found that age,sex,previous fistula surgery,duration of symptoms,and location and level of the internal opening did not significantly influence continence after fistulotomy.The risk of postoperative incontinence was shown to be greater for females than for males,but the difference was not statistically significant.It is commonly believed that women are more prone than men to incontinence after surgical treatment for an anterior fistula because of the smaller sphincter mechanism that may also be impaired by vaginal childbirth[3].Multivariate analysis showed a history of multiple surgical drainages to be an independent predictor of postoperative incontinence.A possible explanation is that repeated abscess formation and prolonged inflammation impair anal sphincter function.In addition,repeated surgical drainage might damage small nerves and create more scar tissue around the anorectum[2].Therefore,to prevent repeated abscess formation and avoid multiple surgical drainages,fistulotomy may be advocated immedi-ately after the abscess has drained adequately and inflam-mation has stabilized.Previous report demonstrated that the sensitivity and specificity of digital rectal examination in distinguishing between the competent and the incompetent sphincter is only in the order of60%[19].Anal manometry provides objective data about the competent parts of the sphincter complex.Therefore,we hypothesized that anal manometry is of value in orientating a surgical policy for treatment and improving the clinical and functional results following surgery for anal fistula.There are a few reported manometric studies of intersphincteric fistula.Chang and Lin[7]examined45 patients with intersphincteric fistula and showed low preoperative resting pressure to be the only independent factor predictive of postoperative incontinence.To the contrary,Lunniss et al.[1]failed to show the significance of preoperative manometric parameters for predicting anal incontinence after fistula surgery.In the present study, univariate and multivariate analyses showed low voluntary contraction pressure,as a reflection of external sphincter function,to be a predictive factor for incontinence after fistulotomy.Division of the internal sphincter cannot be compensated for by tonic contraction of the external sphincter,especially in patients with low preoperative voluntary contraction pressure.These results suggest that anal manometry can indicate the risk of incontinence after fistulotomy for intersphincteric fistula and can guide the choice of the proper surgical intervention that will protect the sphincter mechanism.Our results showed that intersphincteric fistula with an intact anal sphincter can be treated satisfactorily by techniques that lay open the fistula tract.Therefore, fistulotomy appears to be the most effective means of eradicating a fistula track,and many patients will accept a minor degree of incontinence to be cured of a troublesome fistula with its associated mucus discharge,recurrent sepsis, pruritus and disability.However,sphincter-preserving treat-ment,such as fistulectomy with an advancement flap,fibrin glue injection[20,21],or anal fistula plug[22,23],may be Table2Results of multivariate binary logistic regression analysis Parameters Relativerisk95%ConfidenceintervalP valueSex0.9630.224–4.1430.9592 Age0.9070.367–2.2450.8332 Previous drainage surgery 1.971 1.013–3.8340.0457 Previous fistula surgery 1.4020.138–14.2710.7752 Preoperative maximum restingpressure1.1850.484–2.9030.7102 Preoperative voluntarycontraction pressure2.716 1.107–6.6660.0291 Preoperative anal canal length0.6180.259–1.4790.2800Table1Factors affecting postoperative incontinence score after fistulotomy for intersphincteric fistula-in-ano(n=148)Factor Number(n)Postoperativeincontinence scoreP valueAge(years)–41750.6800.9695a 42–730.699SexMale1350.6670.7102a Female130.923Previous fistula surgeryAbsent1420.6900.9063a Present60.667Duration of symptoms(month)–3790.7340.7821a 4–690.638Previous drainage surgery0630.4740.1256b 1720.7642–13 1.308Location of internal openingAnterior190.4740.6568c Lateral260.923Posterior1030.670Level of internal openingHigh6 1.0000.9755c Intermediate800.688Low620.670Operation time(min)–15740.7970.8741a 16–740.581Preoperative maximum resting pressure(mmHg)–83730.7400.9325a 83–750.640Preoperative voluntary contraction pressure(mmHg)–165730.9730.0285a 165–750.413Preoperative anal canal length(cm)–3.90740.5140.339a3.90–740.865a Mann–Whitney U testb Spearman’s rank correlationc One-way ANOV Arequired for patients with intersphincteric fistula,especially with mid-or high internal opening,who show low voluntary contraction pressure preoperatively or those who have undergone multiple abscess drainage surgeries. However,because the follow-up period in the present study was short,further investigation is warranted. ConclusionFistulotomy provides a satisfactory outcome in terms of eradicating sepsis and preserving function in the vast majority of patients with intersphincteric fistula with intact sphincters. 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