治愈率肛門括約肌功能目前一頁\總數(shù)三十四頁\編于十七點(diǎn)高位瘺管定義Ahighfistulawasdefinedasoneencompassingmorethanone-thirdoftheexternalsphinctercomplex.（瘺管侵犯1/3以上的外括約?。〧emalepatientsareprobablyatriskbecausetheyhaveashorterexternalanalsphincteranteriorly,whichispronetodamageduringchildbirth（女性前側(cè)外括約肌較短，且在分娩時可能被損傷）vanKoperenPJ.Long-termfunctionaloutcomeandriskfactorsforrecurrenceaftersurgicaltreatmentforlowandhighperianalfistulasofcryptoglandularorigin.DisColonRectum.2008;51(10):1475-81vanKoperenPJ.Fibringlueandtransanalrectaladvancementflapforhightranssphinctericperianalfistulas;isthereanyadvantage?IntJColorectalDis.2008;23(7):697-701SultanAH.Anal-sphincterdisruptionduringvaginaldelivery.NewEnglJMed1993;329:1905-11FitzpatrickM.Prospectivestudyoftheinfluenceofparityandoperativetechniqueontheoutcomeofprimaryanalsphincterrepairfollowingobstetricalinjury.EurJObstetGynecolReprodBiol2000;89:159-63目前二頁\總數(shù)三十四頁\編于十七點(diǎn)保留括約肌手術(shù)方法目前三頁\總數(shù)三十四頁\編于十七點(diǎn)MatosD(1993)首先報道了經(jīng)括約肌間路徑治療高位肛瘺RojanasakulA(2007)報道經(jīng)括約肌間瘺管結(jié)扎術(shù)(ligationoftheintersphinctericfistulatract,LIFT)MatosD.Totalsphincterconservationinhighfistulainano:resultsofanewapproach.BrJSurg1993;80:802-4.RojanasakulA.Totalanalsphinctersavingtechniqueforfistula-in-ano;theligationofintersphinctericfistulatract.JMedAssocThai2007;90:581-6.目前四頁\總數(shù)三十四頁\編于十七點(diǎn)LIFT適應(yīng)癥目前五頁\總數(shù)三十四頁\編于十七點(diǎn)LigationofIntersphinctericFistulaTractRojanasakulA.Totalanalsphinctersavingtechniqueforfistula-in-ano;theligationofintersphinctericfistulatract.JMedAssocThai2007;90:581-6.治愈率94%目前六頁\總數(shù)三十四頁\編于十七點(diǎn)RojanasakulA.LIFTprocedure:asimplifiedtechniqueforfistula-in-ano.TechColoproctol.2009V13N3:237-40目前七頁\總數(shù)三十四頁\編于十七點(diǎn)愈合與復(fù)發(fā)愈合——括約肌間切口及外口完全愈合失敗括約肌間切口感染——括約肌間切口未愈合，但未形

成括約肌肌間瘺部分失敗——形成括約肌間瘺完全失敗——在原先愈合的部位瘺管再現(xiàn)TanKK.Theanatomyoffailuresfollowingtheligationofintersphincterictracttechniqueforanalfistula:areviewof93patientsover4years.DisColonRectum.2011;54(11):1368-72YassinNA.Ligationoftheintersphinctericfistulatractinthemanagementofanalfistula.Asystematicreview.ColorectalDis.2013;15(5):527-35目前八頁\總數(shù)三十四頁\編于十七點(diǎn)文獻(xiàn)結(jié)果BleierJI;MolooH;GoldbergSM.Ligationoftheintersphinctericfistulatract:aneffectivenewtechniqueforcomplexfistulas.DisColonRectum.2010;53(1):43-6目前九頁\總數(shù)三十四頁\編于十七點(diǎn)Thereasonforthismayhavetodowithetiology

病因(increasednumbersecondarytotuberculosisinThailand),complexity復(fù)雜性(numberofpriorproceduresnotreportedinRojanasakuletal),surgeonexperience手術(shù)者的經(jīng)驗(yàn)

withtheprocedure,orotherunidentifiedfactors不確定因素.BleierJI;MolooH;GoldbergSM.Ligationoftheintersphinctericfistulatract:aneffectivenewtechniqueforcomplexfistulas.DisColonRectum.2010;53(1):43-6目前十頁\總數(shù)三十四頁\編于十七點(diǎn)93例患者，一次性治愈率（40%）+括約肌間瘺管切開術(shù)+二次LIFT=治愈率（57%）WallinUG.Doesligationoftheintersphinctericfistulatractraisethebarinfistulasurgery?DisColonRectum.2012;55(11):1173-8目前十一頁\總數(shù)三十四頁\編于十七點(diǎn)WallinUG.Doesligationoftheintersphinctericfistulatractraisethebarinfistulasurgery?DisColonRectum.2012;55(11):1173-8目前十二頁\總數(shù)三十四頁\編于十七點(diǎn)治愈率低的可能原因多次手術(shù)治療（32%）馬蹄形肛瘺或多發(fā)肛瘺（16%）非單一手術(shù)醫(yī)師（9），存在學(xué)習(xí)曲線和手術(shù)方式的差異性WallinUG.Doesligationoftheintersphinctericfistulatractraisethebarinfistulasurgery?DisColonRectum.2012;55(11):1173-8目前十三頁\總數(shù)三十四頁\編于十七點(diǎn)TanKK.Theanatomyoffailuresfollowingtheligationofintersphincterictracttechniqueforanalfistula:areviewof93patientsover4years.DisColonRectum.2011;54(11):1368-72目前十四頁\總數(shù)三十四頁\編于十七點(diǎn)TanKK.Theanatomyoffailuresfollowingtheligationofintersphincterictracttechniqueforanalfistula:areviewof93patientsover4years.DisColonRectum.2011;54(11):1368-72目前十五頁\總數(shù)三十四頁\編于十七點(diǎn)TanKK.Theanatomyoffailuresfollowingtheligationofintersphincterictracttechniqueforanalfistula:areviewof93patientsover4years.DisColonRectum.2011;54(11):1368-72目前十六頁\總數(shù)三十四頁\編于十七點(diǎn)TanKK.Theanatomyoffailuresfollowingtheligationofintersphincterictracttechniqueforanalfistula:areviewof93patientsover4years.DisColonRectum.2011;54(11):1368-72目前十七頁\總數(shù)三十四頁\編于十七點(diǎn)復(fù)發(fā)性瘺管17例復(fù)發(fā)性瘺管16周臨床隨訪：11(65%)完全閉合，2(12%)感染竇道，4例(23%)瘺管持續(xù)存在終點(diǎn)時間(13.5月）：2例失訪；47%(7/15)愈合，13%(2/15)肌間切口形成竇道，40%(6/15)瘺管持續(xù)存在(4)或復(fù)發(fā)(2)沒有肛門自控功能的進(jìn)一步損害Lehmann,JP.EfficacyofLIFTforrecurrentanalfistula.ColorectalDis.2013(15)5:592-5目前十八頁\總數(shù)三十四頁\編于十七點(diǎn)LIFT應(yīng)該作為保留括約肌手術(shù)的首選方法AbcarianAM.Ligationofintersphinctericfistulatract:earlyresultsofapilotstudy.DisColonRectum.2012;55(7):778-82

目前十九頁\總數(shù)三十四頁\編于十七點(diǎn)Mata分析結(jié)果YassinNA.Ligationoftheintersphinctericfistulatractinthemanagementofanalfistula.Asystematicreview.ColorectalDis.2013;15(5):527-35目前二十頁\總數(shù)三十四頁\編于十七點(diǎn)總病例：498例年齡：18~93歲腺源性肛瘺：494（99%）隨訪時間：1~55月（中位隨訪時間4~19.5月）治愈率：40~95%，平均71%（352/495，3例失訪）肛門功能評估：6%（11/183）輕度肛門失禁術(shù)后疼痛、術(shù)后患者滿意度、恢復(fù)正常生活時間：優(yōu)并發(fā)癥：外痔血栓形成1例

出血3例經(jīng)括約肌肛瘺470（94%）括約肌間瘺11例括約肌上方瘺9例直腸陰道瘺4例YassinNA.Ligationoftheintersphinctericfistulatractinthemanagementofanalfistula.Asystematicreview.ColorectalDis.2013;15(5):527-35目前二十一頁\總數(shù)三十四頁\編于十七點(diǎn)結(jié)論LIFT手術(shù)推薦的適應(yīng)癥為經(jīng)括約肌肛瘺長期隨訪結(jié)果顯示，2/3的患者LIFT治愈LIFT對肛門功能影響較小，僅6%的患者存在輕微肛門功能下降高位經(jīng)括約肌肛瘺或括約肌上方瘺由于分離平面較深和之前手術(shù)疤痕，導(dǎo)致手術(shù)操作受限YassinNA.Ligationoftheintersphinctericfistulatractinthemanagementofanalfistula.Asystematicreview.ColorectalDis.2013;15(5):527-35目前二十二頁\總數(shù)三十四頁\編于十七點(diǎn)BioLIFTLIFT+生物補(bǔ)片：瘺管縫扎后，在括約肌間切口內(nèi)放置生物補(bǔ)片進(jìn)行加強(qiáng).至少隨訪1年，治愈率94%（29/31）LIFT+肛瘺栓中位隨訪時間14月，治愈率95%（20/21）NealEllisC.Outcomeswiththeuseofbioprostheticgraftstoreinforcetheligationoftheintersphinctericfistulatract(BioLIFTprocedure)forthemanagementofcomplexanalfistulas.DisColonRectum.2010;53(10):1361-4HanJG.LigationoftheIntersphinctericFistulaTractPlusBioprostheticAnalFistulaPlug(LIFT-Plug):aNewTechniqueforFistula-in-Ano.ColorectalDis.2012'AcceptedArticle',doi:10.1111/codi.12062目前二十三頁\總數(shù)三十四頁\編于十七點(diǎn)HanJG.LigationoftheIntersphinctericFistulaTractPlusBioprostheticAnalFistulaPlug(LIFT-Plug):aNewTechniqueforFistula-in-Ano.ColorectalDis.2012'AcceptedArticle',doi:10.1111/codi.12062目前二十四頁\總數(shù)三十四頁\編于十七點(diǎn)DudukgianH.Whydowehavesomuchtroubletreatinganalfistula?WorldJGastroenterol2011,28;17(28):3292-96目前二十五頁\總數(shù)三十四頁\編于十七點(diǎn)單中心研究結(jié)果分析

（單一醫(yī)師操作）目前二十六頁\總數(shù)三十四頁\編于十七點(diǎn)

患者一般情況平均年齡（范圍）y38.2（25~62）性別男18女6吸煙否15是9肛瘺病史3.4（6月~20年）肛瘺病因腺源性感染23TB感染1手術(shù)史8/24（1~3次）瘺管分類單一經(jīng)括約肌肛瘺14馬蹄形肛瘺8多發(fā)性肛瘺2外口與瘺管位置前側(cè)8后側(cè)6（2例多發(fā)瘺管）側(cè)方2馬蹄形彎曲瘺8目前二十七頁\總數(shù)三十四頁\編于十七點(diǎn)AbcarianAM.Ligationofintersphinctericfistulatract:earlyresultsofapilotstudy.DisColonRectum.2012;55(7):778-82

目前二十八頁\總數(shù)三十四頁\編于十七點(diǎn)BCDEFGA目前二十九頁\總數(shù)三十四頁\編于十七點(diǎn)目前三十頁\總數(shù)三十四頁\編于十七點(diǎn)目前三十一頁\