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치루의 후향적 분석과 임상적 고찰

A Retrospective Analysis and Clinical Review of Fistula-in-Ano

대한대장항문학회지 1999년 15권 4호 p.321 ~ 330
이용직 ( Lee Yong-Jik ) - 성분도병원 외과

이미옥 ( Lee Mi-Ook ) - 부산성분도병원 일반외과
김성수 ( Kim Sung-Soo ) - 부산성분도병원 일반외과
이영택 ( Lee Young-Teak ) - 부산성분도병원 일반외과
박용기 ( Park Young-Ki ) - 부산성분도병원 일반외과
최창록 ( Choi Chang-Rok ) - 부산성분도병원 일반외과

Abstract


Purpose: The results for treatment of fistula-in-ano have much improved, along with the development of anatomical knowledge, classification, and operative techniques, during last several decades. The authors retrospectively reviewed the results for treatment of fistula-in-ano, especially complex fistulas, during the last 11 years.

Methods: A retrospective study of fistula-in-ano was performed for 229 patients who had been operated on in St. Benedict Hospital between January 1988 and December 1998. Complex fistulas (IIH, III & IV) were analyzed separately.

Results: The most common type was IILs (92 cases, 40.2%), and the most common horseshoe type was IIIBc (5 cases, 2.2%). The average hospital stay was 11.5 days for all fistula-in-ano types, but 15.1 days for complex fistulas. Non-specific inflammation (209 cases, 91.3%) was the most common pathologic finding. Various operative procedures were used : fistulotomy (80 cases, 34.9%), fistulectomy (74 cases, 32.3%), coring out fistulectomy (63 cases, 27.5%), seton technique (11 cases, 4.8%), and muscle-filling technique (1 case, 0.4%). There was no difference in the recurrence rate among the operative types. Various procedures were tried for complex fistulas, but the sphincter-preserving fistulectomy by Taka no seemed to have a low recurrence rate and a short postoperative course. However, because of the small number of cases, this difference in recurrence rate and postoperative course was not statistically significant. The overall postoperative complication rate was 7%: anal infection (4 cases, 1.7%), anal bleeding (3 cases, 1.3%), and urinary retention (2 cases, 0.9%).

Conclusion: The operations for most of the fistulae, IH, IL & IIL, were simple and uneventful. However, the operations for complex fistulae were complicated and more skill was required. We have thought Takano’s operation to be a good curative procedure with less postoperative deformity and shortened postoperative course. However this research couldn’t prove that with statistical significance, probably because of the insufficient number of patients. If further cases are collected and continuous follow-up is done, then a better result can be expected.

키워드

Fistula in ano;Sumikoshi’s classification;Complex fistula;Takano’s sphincter preserving fistulectomy
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