In recent years, although we have made significant progress in the precise diagnosis and treatment of anal fistula, we still lack a thorough and in-depth understanding about the mechanism of formation, development, nonunion and recurrence of complex anal fistula. As a result, there is still a high failure rate, recurrence rate and the risk of the fecal incontinence after treatment. There is hardly any consensus on whatever treatment options, and the various treatment also means no established standard treatment for complex anal fistula. According to recent relevant literatures and personal experience, discuss recent pathbreaking updates in the management of complex anal fistula, we systematically summarize and generalize some critical issues in the diagnosis and treatment of complex anal fistula, including the pathogenesis, reasonable classification criteria, preoperative evaluation and surgical procedure selection. At the same time, we envision the future development directions.
近年来，对于肛瘘的精确诊断和精准治疗虽有了长足进展，但对复杂性肛瘘形成、发展、不愈合和复发的机制仍缺乏全面而深入的理解，因而治疗后仍存在较高的失败率、复发率和肛门功能损伤率。现有的治疗方案没有达成共识，治疗方式的多样性也说明目前尚没有一种公认的治疗复杂性肛瘘的标准方式。本文旨在通过回顾相关文献，并结合自身的临床实践，对复杂性肛瘘诊治过程中遇到的一系列问题，包括发病机制、分型标准、术前评估以及术式选择等进行系统地归纳和总结，同时展望未来的发展方向。.