Диагностика и лечение неполных внутренних свищей прямой кишки

Цель обзора. Представить данные литературы по диагностике и лечению неполных внутренних свищей прямой кишки. Основные положения. Неполные внутренние свищи прямой кишки - это «ниша» в проктологии, которая недостаточно изучена. Во-первых, само определение является терминологической «прорехой», которая не позволяет выделить группу свищей подобного типа как отдельную нозологическую форму. Во-вторых, из-за необходимости проведения сложных диагностических мероприятий (ввиду отсутствия наружного отверстия) затруднено дооперационное определение архитектоники свищевого хода. В связи с этим стандартного лечения свища подобного типа не существует. По данным литературы, частота рецидивов неполных внутренних свищей составляет 8-22%. Заключение. Анализ литературы показал, что имеется небольшое количество работ, в которых освещается данная проблема. Ввиду отсутствия классификации данной патологии не существует единой тактики ее лечения, которая позволила бы не только снизить риск развития рецидива, но и сохранить функцию удержания.

неполный внутренний свищ пря-мой кишки, иссечение свища, ликвидация свища, сегментарная проктопластика, LIFT, межсфинктер-ный абсцесс, супрасфинктерный абсцесс, магнит-но-резонансная томография, ультразвуковое иссле-дование, аноректальная манометрия

1. Аминев А.М. Руководство по проктологии. М., 1973; 3:163-345

2. Блинничев Н.М. Острый и хронический парапроктит (этиология, патогенез, клиника, диагностика, новое в оперативном лечении): Дис. … д-ра мед. наук. - 1972.

3. Дульцев Ю.В., Саламов К.Н. Парапроктит. М.; 1981

4. Eisenhammer S. The final evaluation and classification of the surgical treatment of the primary anorectal cryptoglandular intermuscular (intersphincteric) fistulous abscess and fistula. Dis Colon Rectum 1978; 21(4):237-54.

5. Marks C. G., Ritchie J.K. Anal fistulas at St Mark’s Hospital. Br J Surg 1977; 64(2):84-91.

6. Sainio P. Fistula-in-ano in a defined population. Incidence and epidemiological aspects. Ann Chir Gynaec 1984; 73(4):219-24.

7. Zanotti C. et al. An assessment of the incidence of fistulain-ano in four countries of the European Union. Int J Colorectal Dis 2007; 22(12):1459-62.

8. Предыбайло С.М. Хирургическое лечение неполных внутренних свищей прямой кишки: Дис. … канд. мед. наук. 1990

9. Иброхимов Ю.Х. Диагностика и лечение неполных внутренних свищей прямой кишки: Дис. канд. мед. наук, 2015.

10. Barwood N. et al. Fistula-in-ano: a prospective study of 107 patients. Austral and New Zealand J Surg 1997;67(23):98-102.

11. Kim J.W. et al. Comparative review of perianal sinus & fistula in ano. J Korean Soc Coloproctol 2000; 16(1):7-11.

12. Gupta P.J. A study of suppurative pathologies associated with chronic anal fissures. Tech Coloproctol 2005; 9(2):104-7.

13. Ommer A. et al. Cryptoglandular anal fistulas. Dtsch Ärzteblatt Int 2011; 108(42): 707-13.

14. Bock J.U., Jongen J. The anal fissure-conventional therapy. FALK SYMPOSIUM. Dordrecht; London: Kluwer Academic; 1999, 2001.

15. Naldini G. et al. Hiding intersphincteric and transphincteric sepsis in a novel pathological approach to chronic anal fissure. Surg Innovation 2012; 19(1): 33-6.

16. Wang D. et al. Risk factors for anal fistula: a case-control study. Tech Coloproctol 2014; 18(7):635-9.

17. Jackman R.J. Operation for anal fistulas: Some reasons for failures. Am J Surg 1945; 68(3):323-5.

18. Parks A.G., Gordon P.H. A classification of fistula-inano. Br J Surg 1976; 63: 1-12.

19. Abou-Zeid A.A. Anal fistula: Intraoperative difficulties and unexpected findings. World J Gastroenterol 2011; 17(28): 3272-6.

20. Орлова Л.П., Тихонов А.А., Титов А.Ю., Чубаров Ю.Ю., Полякова Н.А. Ультразвуковой и рентгенологический методы исследования в диагностике экстрасфинктерных свищей прямой кишки. Ультразвуковая и функциональная диагностика 2012; 1:24-31.

21. Pinsk I., Seppala R., Friedlich M.S. Anography: a technique for determining the location of the internal opening in perianal fistula. Colorectal Dis 2010; 12(9):896-900.

22. Brillantino A. et al. Role of tridimensional endoanal ultrasound (3D-EAUS) in the preoperative assessment of perianal sepsis. Int J Colorectal Dis 2015; 30(4): 535-42.

23. Toyonaga T. et al. Comparison of accuracy of physical examination and endoanal ultrasonography for preoperative assessment in patients with acute and chronic anal fistula. Tech Coloproctol 2008; 12(3):217-23.

24. Wedemeyer J. et al. Transcutaneous perianal sonography: a sensitive method for the detection of perianal inflammatory lesions in Crohn’s disease. World J Gastroenterol 2004; 10(19):2859-63.

25. Youssef A.T. Imaging Classification of Perianal Fistula Using the Ultrasound. J Gastroenterol Hepatol Res 2015; 4(6):1653-9.

26. Garcia-Granero A. et al. Management of cryptoglandular supralevator abscesses in the magnetic resonance imaging era: a case series. Int J Colorectal Dis 2014;29(12):155764.

27. Siddiqui M.R.S. et al. A diagnostic accuracy meta-analysis of endoanal ultrasound and MRI for perianal fistula assessment. Dis Colon Rectum 2012; 55(5):576-85.

28. Arroyo A. et al. Fistulotomy and sphincter reconstruction in the treatment of complex fistula-in-ano: long-term clinical and manometric results. Ann Surg 2012; 255(5):935-9.

29. Jordán J. et al. Risk factors for recurrence and incontinence after anal fistula surgery. Colorectal Dis 2010;12(3): 254-60.

30. Toyonaga T. et al. Factors affecting continence after fistulotomy for intersphincteric fistula-in-ano. Int J Colorectal Dis 2007; 22(9):1071-5.

31. Visscher A.P. et al. Long-term Follow-up After Surgery for Simple and Complex Cryptoglandular Fistulas: Fecal Incontinence and Impact on Quality of Life. Dis Colon Rectum 2015; 58(5):533-9.

32. Roig J.V. et al. Changes in anorectal morphologic and functional parameters after fistula-in-ano surgery. Dis Colon Rectum 2009; 52(8):1462-9.

33. Vial M. et al. Faecal incontinence after seton treatment for anal fistulae with and without surgical division of internal anal sphincter: a systematic review. Colorectal Dis 2010; 12(3):172-8.

34. Chang S.C., Lin J.K. Change in anal continence after surgery for intersphincteral anal fistula: a functional and manometric study. Int J Colorectal Dis 2003; 18(2):111-5.

35. Gabriel W.B. The treatment of pruritus ani and anal fissure. Br Med J 1930; 2(3634):311.

36. Bernard D., Tasse D., Morgan S. High intermuscular anal abscess and fistula: analysis of 25 cases. Can J Surg 1983 Mar.; 26(2):136-9.

37. GÖttgens K.W.A. et al. Long-term outcome of low perianal fistulas treated by fistulotomy: a multicenter study. Int J Colorectal Dis 2015; 30(2):213-9.

38. Hirschburger M. et al. Fistulectomy with primary sphincter reconstruction in the treatment of high transsphincteric anal fistulas. Int J Colorectal Dis 2014; 29(2):247-52.

39. Elting A.W.X. The treatment of fistula in ano: with especial reference to the whitehead operation. Ann Surg 1912; 56(5):744-52.

40. Ramirez A., Virgilio A. Fistulas anorrectales: tratamiento quirurgico con el metodo de Robles y Picot: experiencia personal. Prensa Med Argent 1985; 72(15):511-4.

41. Kirschner M. Die Eingriffe am Mastdarm. Die Eingriffe in der Bauchhohle. Berlin-Heidelberg: Springer-Verlag 1951. 551 p.

42. Rojanasakul A. LIFT procedure: a simplified technique for fistula-in-ano. Tech Coloproctol 2009; 13(3):237-40.

43. Van Onkelen R.S., Gosselink M.P., Schouten W.R. Treatment of anal fistulas with high intersphincteric extension. Dis Colon Rectum 2013; 56(8):987-91.

44. Tan K.K., Koh D.C., Tsang C.B. Managing deep postanal space sepsis via an intersphincteric approach: our early experience. Ann Coloproctol 2013; 29(2):55-9.

45. Garcia-Granero A. et al. The use of an endostapler in the treatment of supralevator abscess of intersphincteric origin. Colorectal Dis 2014; 16(9):O335-O338.

46. Millan M., Garcia-Granero E., Esclápez P. et al.

47. Management of intersphincteric abscesses. Colorectal Dis 2006; 8(9):777-80.

48. GÖttgens K.W.A. et al. Systematic review and metaanalysis of surgical interventions for high cryptoglandular perianal fistula. Int J Colorectal Dis 2015; 30(5):583-93.

49. Kelly M.E. et al. The role of loose seton in the management of anal fistula: a multicenter study of 200 patients. Tech Coloproctol 2014; 18(10):915-9.

50. Singh M.P. et al. New approach to anorectal sinus disease.

51. Lentner A., Volker W. Long-term, indwelling setons for low transsphincteric and intersphincteric anal fistulas. Dis Colon Rectum 1996; 39(10):1097-101.

52. Garg P., Garg M. PERFACT procedure: A new concept to treat highly complex anal fistula. World J Gastroenterol 2015; 21(13):4020-9.

53. de Parades V. et al. Horseshoe tract of anal fistula: bad luck or an avoidable extension? Lessons from 82 cases. Colorectal Dis 2012; 14(12):1512-5. Koehler A., Risse-Schaaf A., Athanasiadis S. Treatment for horseshoe fistulas-in-ano with primary closure of the internal fistula opening: a clinical and manometric study. Dis Colon Rectum 2004; 47(11):18

54. Аминев А.М. Руководство по проктологии. М., 1973; 3:163-345

55. Блинничев Н.М. Острый и хронический парапроктит (этиология, патогенез, клиника, диагностика, новое в оперативном лечении): Дис. … д-ра мед. наук. - 1972.

56. Дульцев Ю.В., Саламов К.Н. Парапроктит. М.; 1981

57. Eisenhammer S. The final evaluation and classification of the surgical treatment of the primary anorectal cryptoglandular intermuscular (intersphincteric) fistulous abscess and fistula. Dis Colon Rectum 1978; 21(4):237-54.

58. Marks C. G., Ritchie J.K. Anal fistulas at St Mark’s Hospital. Br J Surg 1977; 64(2):84-91.

59. Sainio P. Fistula-in-ano in a defined population. Incidence and epidemiological aspects. Ann Chir Gynaec 1984; 73(4):219-24.

60. Zanotti C. et al. An assessment of the incidence of fistulain-ano in four countries of the European Union. Int J Colorectal Dis 2007; 22(12):1459-62.

61. Предыбайло С.М. Хирургическое лечение неполных внутренних свищей прямой кишки: Дис. … канд. мед. наук. 1990

62. Иброхимов Ю.Х. Диагностика и лечение неполных внутренних свищей прямой кишки: Дис. канд. мед. наук, 2015.

63. Barwood N. et al. Fistula-in-ano: a prospective study of 107 patients. Austral and New Zealand J Surg 1997;67(23):98-102.

64. Kim J.W. et al. Comparative review of perianal sinus & fistula in ano. J Korean Soc Coloproctol 2000; 16(1):7-11.

65. Gupta P.J. A study of suppurative pathologies associated with chronic anal fissures. Tech Coloproctol 2005; 9(2):104-7.

66. Ommer A. et al. Cryptoglandular anal fistulas. Dtsch Ärzteblatt Int 2011; 108(42): 707-13.

67. Bock J.U., Jongen J. The anal fissure-conventional therapy. FALK SYMPOSIUM. Dordrecht; London: Kluwer Academic; 1999, 2001.

68. Naldini G. et al. Hiding intersphincteric and transphincteric sepsis in a novel pathological approach to chronic anal fissure. Surg Innovation 2012; 19(1): 33-6.

69. Wang D. et al. Risk factors for anal fistula: a case-control study. Tech Coloproctol 2014; 18(7):635-9.

70. Jackman R.J. Operation for anal fistulas: Some reasons for failures. Am J Surg 1945; 68(3):323-5.

71. Parks A.G., Gordon P.H. A classification of fistula-inano. Br J Surg 1976; 63: 1-12.

72. Abou-Zeid A.A. Anal fistula: Intraoperative difficulties and unexpected findings. World J Gastroenterol 2011; 17(28): 3272-6.

73. Орлова Л.П., Тихонов А.А., Титов А.Ю., Чубаров Ю.Ю., Полякова Н.А. Ультразвуковой и рентгенологический методы исследования в диагностике экстрасфинктерных свищей прямой кишки. Ультразвуковая и функциональная диагностика 2012; 1:24-31.

74. Pinsk I., Seppala R., Friedlich M.S. Anography: a technique for determining the location of the internal opening in perianal fistula. Colorectal Dis 2010; 12(9):896-900.

75. Brillantino A. et al. Role of tridimensional endoanal ultrasound (3D-EAUS) in the preoperative assessment of perianal sepsis. Int J Colorectal Dis 2015; 30(4): 535-42.

76. Toyonaga T. et al. Comparison of accuracy of physical examination and endoanal ultrasonography for preoperative assessment in patients with acute and chronic anal fistula. Tech Coloproctol 2008; 12(3):217-23.

77. Wedemeyer J. et al. Transcutaneous perianal sonography: a sensitive method for the detection of perianal inflammatory lesions in Crohn’s disease. World J Gastroenterol 2004; 10(19):2859-63.

78. Youssef A.T. Imaging Classification of Perianal Fistula Using the Ultrasound. J Gastroenterol Hepatol Res 2015; 4(6):1653-9.

79. Garcia-Granero A. et al. Management of cryptoglandular supralevator abscesses in the magnetic resonance imaging era: a case series. Int J Colorectal Dis 2014;29(12):155764.

80. Siddiqui M.R.S. et al. A diagnostic accuracy meta-analysis of endoanal ultrasound and MRI for perianal fistula assessment. Dis Colon Rectum 2012; 55(5):576-85.

81. Arroyo A. et al. Fistulotomy and sphincter reconstruction in the treatment of complex fistula-in-ano: long-term clinical and manometric results. Ann Surg 2012; 255(5):935-9.

82. Jordán J. et al. Risk factors for recurrence and incontinence after anal fistula surgery. Colorectal Dis 2010;12(3): 254-60.

83. Toyonaga T. et al. Factors affecting continence after fistulotomy for intersphincteric fistula-in-ano. Int J Colorectal Dis 2007; 22(9):1071-5.

84. Visscher A.P. et al. Long-term Follow-up After Surgery for Simple and Complex Cryptoglandular Fistulas: Fecal Incontinence and Impact on Quality of Life. Dis Colon Rectum 2015; 58(5):533-9.

85. Roig J.V. et al. Changes in anorectal morphologic and functional parameters after fistula-in-ano surgery. Dis Colon Rectum 2009; 52(8):1462-9.

86. Vial M. et al. Faecal incontinence after seton treatment for anal fistulae with and without surgical division of internal anal sphincter: a systematic review. Colorectal Dis 2010; 12(3):172-8.

87. Chang S.C., Lin J.K. Change in anal continence after surgery for intersphincteral anal fistula: a functional and manometric study. Int J Colorectal Dis 2003; 18(2):111-5.

88. Gabriel W.B. The treatment of pruritus ani and anal fissure. Br Med J 1930; 2(3634):311.

89. Bernard D., Tasse D., Morgan S. High intermuscular anal abscess and fistula: analysis of 25 cases. Can J Surg 1983 Mar.; 26(2):136-9.

90. GÖttgens K.W.A. et al. Long-term outcome of low perianal fistulas treated by fistulotomy: a multicenter study. Int J Colorectal Dis 2015; 30(2):213-9.

91. Hirschburger M. et al. Fistulectomy with primary sphincter reconstruction in the treatment of high transsphincteric anal fistulas. Int J Colorectal Dis 2014; 29(2):247-52.

92. Elting A.W.X. The treatment of fistula in ano: with especial reference to the whitehead operation. Ann Surg 1912; 56(5):744-52.

93. Ramirez A., Virgilio A. Fistulas anorrectales: tratamiento quirurgico con el metodo de Robles y Picot: experiencia personal. Prensa Med Argent 1985; 72(15):511-4.

94. Kirschner M. Die Eingriffe am Mastdarm. Die Eingriffe in der Bauchhohle. Berlin-Heidelberg: Springer-Verlag 1951. 551 p.

95. Rojanasakul A. LIFT procedure: a simplified technique for fistula-in-ano. Tech Coloproctol 2009; 13(3):237-40.

96. Van Onkelen R.S., Gosselink M.P., Schouten W.R. Treatment of anal fistulas with high intersphincteric extension. Dis Colon Rectum 2013; 56(8):987-91.

97. Tan K.K., Koh D.C., Tsang C.B. Managing deep postanal space sepsis via an intersphincteric approach: our early experience. Ann Coloproctol 2013; 29(2):55-9.

98. Garcia-Granero A. et al. The use of an endostapler in the treatment of supralevator abscess of intersphincteric origin. Colorectal Dis 2014; 16(9):O335-O338.

99. Millan M., Garcia-Granero E., Esclápez P. et al.

100. Management of intersphincteric abscesses. Colorectal Dis 2006; 8(9):777-80.

101. GÖttgens K.W.A. et al. Systematic review and metaanalysis of surgical interventions for high cryptoglandular perianal fistula. Int J Colorectal Dis 2015; 30(5):583-93.

102. Kelly M.E. et al. The role of loose seton in the management of anal fistula: a multicenter study of 200 patients. Tech Coloproctol 2014; 18(10):915-9.

103. Singh M.P. et al. New approach to anorectal sinus disease.

104. Lentner A., Volker W. Long-term, indwelling setons for low transsphincteric and intersphincteric anal fistulas. Dis Colon Rectum 1996; 39(10):1097-101.

105. Garg P., Garg M. PERFACT procedure: A new concept to treat highly complex anal fistula. World J Gastroenterol 2015; 21(13):4020-9.

106. de Parades V. et al. Horseshoe tract of anal fistula: bad luck or an avoidable extension? Lessons from 82 cases. Colorectal Dis 2012; 14(12):1512-5. Koehler A., Risse-Schaaf A., Athanasiadis S. Treatment for horseshoe fistulas-in-ano with primary closure of the internal fistula opening: a clinical and manometric study. Dis Colon Rectum 2004; 47(11):18

107. Koehler A., Risse-Schaaf A., Athanasiadis S. Treatment for horseshoe fistulas-in-ano with primary closure of the internal fistula opening: a clinical and manometric study. Dis Colon Rectum 2004; 47(11):1874-82.