岭南现代临床外科2025，Vol.25Issue(1)：70-74,后插1,6.DOI:10.3969/j.issn.1009-976X.2025.01.012
经肛括约肌间切开术治疗高位及复杂性肛瘘的进展
Progress in the treatment of high and complex anal fistulas by transanal opening of intersphinc-teric space
摘要
Abstract
Surgical treatment of anal fistulas faces the dual challenge of achieving wound healing while preserving anal function.High or complex anal fistulas represent a closed-space,non-functional cavity within the perianal musculature,predominantly occurring in the posterior deep space of the anal sphincter complex.Effective management requires complete opening of this space and ensuring adequate drainage to control infection and promote healing.Traditional fistulotomy with seton placement is primar-ily suitable for simple fistulas,but its application in complex cases often results in high incontinence rates.In the era of sphincter-preserving techniques,surgeons must select appropriate surgical approaches that prioritize the anatomical integrity of the anal sphincter system.Current literature and guidelines propose multiple therapeutic options,including mucosal advancement flap(MAF),laser therapy,video-assisted anal fistula treatment(VAAFT),ligation of intersphincteric fistula tract(LIFT),over-the-scope clip closure(OTSC),and radiofrequency ablation(RAF),however,up to the present moment,no single method has demonstrated substantial and promising potential.The transanal opening of intersphincteric space(TROPIS)technique,introduced in recent years,offers a unique approach.Instead of closing the internal fistula opening,TROPIS enlarges it by incising the fistula tract along the intersphincteric plane.This method fully preserves the external anal sphincter(EAS)and facilitates secondary healing through sustained drainage.Transanal opening of intersphincteric space(TROPIS)is a novel technique devel-oped in recent years for high or complex anal fistulas.Instead of closing the internal fistula opening,it enlarges the opening by incising the fistula tract along the intersphincteric plane,completely preserving the external anal sphincter(EAS)and allowing secondary healing through drainage.First reported in 2017,TROPIS has demonstrated good efficacy and safety in treating complex high anal fistulas and is gaining wider adoption.This article reviews the clinical outcomes and future prospects of TROPIS.关键词
经经肛括约肌间切开术/复杂性肛瘘/外括约肌/进展Key words
transanal opening of intersphincteric space/high and complex anal fistulas/external anal sphincter/progress分类
临床医学引用本文复制引用
郭硕浩,宋顺心..经肛括约肌间切开术治疗高位及复杂性肛瘘的进展[J].岭南现代临床外科,2025,25(1):70-74,后插1,6.基金项目
湖南省卫生健康高层次人才项目(20240304158) （20240304158）
