بررسي تاثير استفاده از فيبرين غني از پلاكت در بهبود زخم هاي ناشي از فيستول هاي داراي كالكشن سوپرالواتور و تاثير آن بر عود فيستول

Evaluation of the effect of using platelet-rich fibrin in healing wounds caused by fistulas with supralevator collection and its effect on fistula recurrence

آبسه هاي سوپرالواتور 9% آبسه هاي كريپتوگلاندولار هستند. فيبرين غني از پلاكت رشد بافتي را تسريع كرده و عفونت را كاهش مي دهد، مطالعه حاضر با هدف بررسي تاثير آن بر بهبود زخم هاي ناشي از فيستول ها و پيشگيري از عود انجام شد.روش بررسي مطالعه به صورت كارآزمايي باليني يك سوكور در بيماران مراجعه كننده به درمانگاه جراحي بيمارستان رسول اكرم (ص) از فروردين 1397 تا فروردين 1399، با تاييد كالكشن سوپرالواتور انجام شد. پيش از عمل جراحي، امتياز وكسنر (Wexner Score) در همه بيماران تعيين شد. حين عمل جراحي مسير فيستول ها و حفره ها شناسايي گرديده و با مقدار مورد نياز فيبرين غني از پلاكت پر شد. نتايج باليني يك روز، تا دو ماه هفته اي يك بار و سپس هر يك ماه تا بهبودي كامل و سپس شش ماه پس از جراحي بررسي شد.يافته ها تعداد 10 نفر در آناليز نهايي شركت داده شدند. ميانگين سني بيماران 20/33 سال بود (46-26 سال). سه نفر سابقه جراحي آبسه پري آنال، دو نفر سابقه جراحي فيستول و يك نفر سابقه جراحي فيشر داشتند. ميانگين زمان بسته شدن حفره 2/14 روز بود (22-10روز). دو نفر (20%) مبتلا به تب و دو نفر (20%) دچار عفونت ناحيه عمل جراحي شدند. خونريزي و عود در هيچ كدام از بيماران مشاهده نگرديد. ميانگين امتياز وكسنر پيش از عمل 76/0±80/0 بود كه پس از عمل به مقدار 68/0±50/0 كاهش يافت (045/0=P). نتيجه گيري استفاده از فيبرين غني از پلاكت براي ترميم فيستول پيچيده روشي است كه به راحتي قابل تكرار است و با حداقل عوارض جانبي مي تواند موجب بهبود زخم هاي ناشي از فيستول هاي داراي كالكشن سوپرالواتور گردد.

Supralevator abscesses make up to 9% of all cryptoglandular abscesses. Given that platelet-rich fibrin accelerates tissue growth and reduces infection, it seems necessary to investigate its effect on the healing of fistula wounds because it can accelerate the healing of morbid wounds and reduce its effect on recurrence. Methods: The study was performed as a single-blind clinical trial in patients who were referred to the surgical clinic of Rasoul Akram Hospital (PBUH), with the approval of the supralevator collection. Before surgery, Wexner Score were identified in patients who underwent surgery, and the entire path of fistulas and cavities was identified. Clinical outcomes were monitored one day after surgery for up to two months once a week, then every month until complete recovery, and then six months after surgery. After the operation, the patients were examined for recurrence, until the PRF was absorbed, the dressing of the operation site was performed only with normal saline, and the patients were on a low-residue diet so that they could not excrete as much as possible. Results: 10 people participated in the final analysis. The mean age of patients was 33.20 years (26-46 years). Three patients had a history of perianal abscess surgery, two patients had a history of fistula surgery and 1 patient had a history of Fisher surgery. The mean closing time of the cavity was 14.2 days (10-22 days). Two patients (20%) had a fever and two patients (20%) had a surgical site infection. Bleeding and recurrence were not observed in any of the patients. The mean preoperative Wexner score was 0.80±0.76 Which decreased to 0.68±0.50 postoperatively (P=0.045). Conclusion: Finally, the findings of the study showed that the use of PRF to repair a complex fistula is a method that can be easily repeated with minimal side effects and can heal wounds caused by fistulas with supralevator collection. This treatment can play an important role in the treatment of complex fistulas that have moderate or extensive involvement with the sphincter, or the occurrence of fistulas with sphincter dysfunction. Keywords: fistula, platelet-rich fibrin, recurrence, treatment. Abstract Received: 31 Jan. 2022 Revised: 07 Feb. 2022 Accepted: 13 Apr. 2022 Available online: 21 Apr. 2022 Original Article Tehran University Medical Journal, May 2022; Vol. 80, No. 2: 99-107 Copyright © 2022 Tehran University of Medical Sciences. Published by Tehran University of Medical Sciences. This work