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1、AnalFistulaPlugforClosureofDifficultAnorectalFistula:AProspectiveStudy122PaulJ.vanKoperen,M.D.,AndreD_Hoore,M.D.,Ph.D.,AlbertM.Wolthuis,M.D.,11WillemA.Bemelman,M.D.,Ph.D.,J.FrederikM.Slors,M.D.,Ph.D.1DepartmentofSurgery,AcademicMedicalCenter,Amsterdam,TheNetherlands2DepartmentofAbdominalSur
2、gery,Gasthuisberg,UniversityClinics,Leuven,BelgiumPURPOSE:Complexhighandrecurrentfistulasremainaopeningwhilepreservingcontinence.Submucosal,surgicalchallenge.Simpledivision,i.e.,fistulotomy,willintersphincteric,andlowtranssphinctericfistulasinlikelyresultinfecalincontinence.Varioussurgicalt
3、reat-thelowerone-thirdoftheexternalsphinctercom-mentoptionsforthesefistulashaveshowndisappointingresults.Recentlyabiologicanalfistulaplugwasdevelopedplexareeasytotreatbysimplefistulotomy,withatotreatthesehightranssphinctericfistulas.Toassessthefavorablesuccessrateandrelativelylittleimpacton
4、resultsoftheanalfistulapluginpatientswithcomplexfecalcontinence.highperianalfistulas,aprospective,two-center,clinicalstudywasundertaken.METHODS:BetweenApril2006andHightranssphinctericfistulasremainasurgicalOctober2006,aconsecutiveseriesofpatientswithdifficultchallenge.Simpledivision,i.e.,fi
5、stulotomy,willtherapy-resistanthighfistulaswereenrolled.Duringsur-likelyresultinfecalincontinence.1–3Inrecentyears,gery,theinternalfistulatractopeningwasidentified.Aconicalshapedcollagenplugwaspulledthroughthefistulamanyoptionshavebeenexploredtosuccessfullytract.Anyremainingportionoftheplug
6、thatwasnottreatthesedifficultperianalfistulas.Surgicalproce-implantedinthetractwasremoved.Theplugwasfixedatduressuitableforhighfistulasincludeadvancementtheinternalopeningwithadeep3/0polydioxanoneflaps,loose-setonplacement,installationoffibrinsuture.RESULTS:Seventeenpatientswithamedianageof
7、45(range,27–75)yearswereincluded.Ofthesepatients,glue,anddivertingstoma.Unfortunatelythesetech-71percent(12/17)weremale.Atamedianlengthofniqueshavedisappointingsuccessrates.4–7follow-upof7(range,3–9)months,7of17fistulashad8Champagneetal.reportedanewbiolo