Хірургічне лікування екстрасфінктерних нориць з використанням алогенного колагенового імплантату

Abstract

Проведене дослідження показало, що хірургічне лікування хворих з екстрасфінктерними норицями з висіченням внутрішнього отвору нориці та закриттям цієї ділянки дефекту алогенною колагеновою плівкою забезпечує ефективну регенерацію сполучної тканини і на 11,7% зменшує кількість рецидивів нориць. Доведено, що властивості алогенної колагенової плівки дають змогу забезпечити постійне закріплення м’яких тканин ділянки хірургічного втручання навіть в присутності бактеріальної інфекції; Проведенное исследование показало, что хирургическое лечение больных с экстрасфинктерными свищами с иссечением внутреннего отверстия свища и закрытия этой области дефекта аллогенной коллагеновой пленкой обеспечивает эффективную регенерацию соединительной ткани и на 11,7% снижает количество рецидивов свища. Доказано, что свойства аллогенной коллагеновой пленки обеспечивают закрепление мягких тканей участка хирургического вмешательства в присутствии бактериальной инфекции; The aim of the work is to improve the results of surgical treatment of extrasphincter fistulas. Object and methods. In the clinic of the Department of surgery and proctology for the period from 2012 to 2017, 53 patients with extrasphincter fistulas were operated. The age of the patients ranged from 25 to 60 years. The average age is 52.3 ± 2.1 years. Males 31 (58.4%), women – 22 (41.5%). 25 (47.1%) patients were diagnosed with extrasphincter fistulas of the 1st degree of difficulty, 15 (28.3%) of the 2nd, 7 (13.2%) of the 3rd and 6 (11.3%) 4th degree of complexity. Depending on the technique of surgical treatment, the patients were divided into 2 groups. The first group consisted of 27 patients, which performed our developed surgical treatment using a biological allogenic collagen implant. The second group consisted of 26 patients who performed the classic methods of excision of the fistulas of the rectum. Fistulotomy was performed in 9 (34.6%) patients, Fistulectomy (excision of the fistula in the gut lumen) in 7 (26.9%) and Seton Placement (ligating overlay) at 10 (38.4%) patients. Research results and their discussion. In the first group of patients, suppuration of the wound occurred in 1 (3.7%) patients, in 3 (11.1%) serous inflammation of the postoperative wound, which was eliminated by drainage and the appointment of anti-inflammatory therapy (diclofenac 3.0 1 times/m), anal incontinence in patients was not marked. The wound healed for 10 ± 1.2 days. In the second group of patients in the early postoperative period there were local complications in the form of suppurative wounds in 7 (26.9%) patients, partial incontinence of gases appeared in 6 (23.0%) patients, anal incontinence of the 1st degree was noted at 6 (23.0%), stable anal incontinence arose in 4 (15.3%), the wound was healed for 24 ± 2.3 days. Long-term results of treatment, which were studied from 1 to 24 months, by surveys and questionnaires of 21 patients in the first group and 22 patients in the second group. Relapse in the first group occurred in 1 (3.7%) of the patient in the second group occurred in 4 (15.4%) patients. In addition, in the second group, stable anal incontinence was observed in 3 (13.6%) and partial incontinence gases in 4 (18.1%) patients. Conclusions. The proposed technique reduced the number of relapses in patients with extrasphincter fistulas after surgical treatment by 11.7% compared with the classical ones. Local use of a lyophilized allogeneic collagen implant promotes accelerated formation of own collagen in the patient’s tissues, which leads to a rapid closure of the defect.