OTSC应用于肛瘘上的治疗

塔**海

吻合器直肠黏膜切除术由德国外科医生Ruediger Prosst首创和临床实施。该术式适合于内口在齿线以上的高位括约肌上或括约肌外肛瘘，不损伤括约肌、有效保护**功能，术后恢复快、痛苦小。国外的报道一期治愈率可达90%，对于复发性的肛瘘治愈率在70%。

英文原版就不逐句翻译了，简单翻译一下大致步骤，附上原文，感兴趣的自己看一下吧。再附上一段该手术的视频。

尊重著作权人合法权益，该附件版权审核中

Treatment of Anal Fistula using Ovesco OTSC Proctology.mp4 (40.07 MB, 下载次数: 4, 售价: 1 爱医币)

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1、探查瘘道并挂线引流：术前必须保证无脓肿且无较大的感染，一般需提前充分引流2-3个月。

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2、在内口处切除直径为2cm的黏膜，需避开神经敏感处以避免疼痛的发生。

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3、使用瘘管刷充分清创去除瘘管内的碎屑和肉芽组织

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4、精密对准内口与OTSC吻合口，内口必须完全拉入仪器吻合口内，内口周围括约肌使用可吸收线十字缝合，以保证中心的组织能够被完全拉入吻合口。

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5、缝合线打结准备拉入吻合器

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6、修正OTSC位置：拉紧缝合线，使内口完全对应吻合口。

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7、当确认吻合口已经完全正对内口周围曝露的括约肌后，钉入吻合夹。

注意：当内口封闭完成后，必须保证瘘管内无感染，外口处应同时切开，并防止假性愈合。




Initially, it is advisable to manage the pre-treatment of the fistula before surgery like in other therapeutic procedures.

Step 1: Fistula is probed and seton inserted
Before application of the OTSC Proctology it must be guaranteed that no abscess or other major infection is present along the tract of the fistula. As for preparation in other therapies this can be achieved with the placement of a seton drainage for approx. two to three months before clip application.

Step 2: Excision of a circular area of anoderm
Excision of a circular area of anoderm of approx. two centimeters in diameter around the internal opening of the fistula to avoid possible pain due to the sensitive anoderm. The clip is then applied to the stable sphincter muscle.

Step 3: Debridement and removal of granulative tissue
Before OTSC Proctology application, the special Fistula Brush can be used to remove the granulation tissue and debris lining the fistula tract. To facilitate introduction of the brush into the outer fistula orifice the seton for drainage is attached to loop of the brush. Alternatively the brush can be directly inserted with its round end carefully. After debridement of the fistula tract by alternating movements of the brush, the tract is rinsed with appropriate rinsing solution (e.g. saline). The shaft of the brush can be used to indicate the internal opening of the fistula.

Step 4: Precise alignment with sutures or OTSC Proctology Anchor
The first step of OTSC placement is the precise alignment between the applicator cap and the inner fistula orifice. The area of the inner fistula orifice has to be pulled into the cap or has to be at least firmly into contact with the cap of the OTSC Proctology applicator.

The area around the internal fistual opening is stitched cross-like with two resorbable U-shaped threads, placed through the sphincter muscle. This ensures central pulling of tissue into the application cap of the OTSC Proctology applicator.

In case the fistula cannot be reached with sutures, the fistula can be grasped and pulled using the OTSC Proctology Anchor which can be inserted to the working channel of the instrument.

Step 5: Knotting of sutures
The sutures are knotted at their distal end to allow them to be pulled through the working channel of the OTSC Proctology applicator using the thread retriever.


Step 6: Correct positioning of OTSC Proctology
By holding the sutures under slight tension, the preloaded OTSC Proctology is advanced towards the internal opening of the fistula. The sutures are the guidance on which the applicator is advanced to the internal opening of the fistula tract. The OTSC Proctology has to be aligned in parallel to the axis of the ** c** to achieve an anatomically correct orientation of the clip shape within the anorectum.

Step 7: OTSC Proctology Clip Application
The applicator cap is centered and brought into stable contact with the exposed sphincter muscle around the opening of the fistula. Misplacement or dislocation of the applicator has to be avoided, using the guidance provided by the sutures, which enable a correct placement on the fistula opening.

After folding away the safety lock, the deployment trigger of the applicator is pressed and the deployment ring shoves the clip off the applicator cap.


Note: Once having closed the inner orifice of the fistula the drainage of the fistula tract and/or abscess is mandatory in order to achieve the best possible result. A dissection of the outer orifice should be performed. This might be followed by placing gauze or similar within the fistula tract to hinder the surrounding skin to accomplish closure of the fistula followed by abscess formation and fistula relapse.

s****6

学习了，谢谢了