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第1篇一、医学基础知识1. 请简述人体呼吸系统的组成及功能。
2. 解释一下什么是血压，正常血压范围是多少？3. 请简述心脏的结构和功能。
4. 简述消化系统的组成和功能。
5. 请简述血液的组成及功能。
6. 解释一下什么是免疫系统，它的主要功能是什么？7. 简述神经系统的组成和功能。
8. 请简述内分泌系统的组成和功能。
9. 解释一下什么是血糖，正常血糖范围是多少？10. 简述泌尿系统的组成和功能。
二、临床医学1. 请简述病史采集的重要性。
2. 解释一下什么是体检，它包括哪些内容？3. 简述临床诊断的基本原则。
4. 请简述药物治疗的基本原则。
5. 解释一下什么是药物不良反应，如何预防和处理？6. 简述临床医学伦理的基本原则。
7. 请简述医学影像学的基本原理和应用。
8. 简述实验室检查的基本原理和应用。
9. 解释一下什么是临床病理学，它的主要作用是什么？10. 简述临床治疗的基本原则。
三、内科疾病1. 请简述高血压的诊断标准及治疗方法。
2. 解释一下什么是冠心病，它的主要临床表现有哪些？3. 简述慢性阻塞性肺疾病的诊断标准及治疗方法。
4. 请简述糖尿病的诊断标准及治疗方法。
5. 解释一下什么是心力衰竭，它的主要临床表现有哪些？6. 简述慢性肾功能不全的诊断标准及治疗方法。
7. 请简述甲状腺功能亢进症的诊断标准及治疗方法。
8. 解释一下什么是支气管哮喘，它的主要临床表现有哪些？9. 简述慢性胃炎的诊断标准及治疗方法。
10. 请简述肝硬化、肝硬化的诊断标准及治疗方法。
四、外科疾病1. 请简述阑尾炎的诊断标准及治疗方法。
2. 解释一下什么是胃溃疡，它的主要临床表现有哪些？3. 简述胆石症的诊断标准及治疗方法。
4. 请简述甲状腺肿瘤的诊断标准及治疗方法。
5. 解释一下什么是直肠癌，它的主要临床表现有哪些？6. 简述骨折的诊断标准及治疗方法。
7. 请简述乳腺肿瘤的诊断标准及治疗方法。
8. 解释一下什么是甲状腺功能减退症，它的主要临床表现有哪些？9. 简述阑尾炎术后并发症及预防措施。
考研外科学模拟面试题及答案一、简答题1. 题目：请简述外科手术前的基本准备有哪些？答案：外科手术前的基本准备包括：(1) 详细病史采集和体格检查；(2) 必要的辅助检查，如血常规、凝血功能、心电图、肝肾功能等；(3) 评估患者的手术风险和手术适应症；(4) 与患者及家属进行术前谈话，明确手术目的、可能的风险和并发症；(5) 术前禁食、禁水，以减少术中呕吐和误吸的风险；(6) 术前皮肤准备，如剃毛、消毒等。
2. 题目：什么是无菌操作原则？答案：无菌操作原则是指在手术过程中，通过一系列措施，防止微生物进入手术区域，以降低感染风险。
这些措施包括：(1) 穿戴无菌手术衣和手套；(2) 使用无菌器械和敷料；(3) 保持手术区域的清洁和干燥；(4) 避免不必要的接触和移动；(5) 正确使用无菌单。
3. 题目：请解释什么是创伤性休克，并简述其处理原则。
答案：创伤性休克是由于严重创伤引起的一种急性循环衰竭状态，常见于大量失血或组织损伤。
处理原则包括：(1) 立即评估患者的生命体征，如血压、心率、呼吸等；(2) 快速补充血容量，如输血、输液；(3) 控制出血源；(4) 维持氧合和通气；(5) 监测和纠正电解质和酸碱平衡紊乱；(6) 必要时进行手术干预。
二、论述题1. 题目：论述外科感染的预防和控制措施。
答案：外科感染的预防和控制措施包括：(1) 严格执行无菌操作规程；(2) 术前和术后使用抗生素预防感染；(3) 保持手术环境的清洁和消毒；(4) 合理选择切口部位和手术方式，减少组织损伤；(5) 术后密切观察切口愈合情况，及时发现和处理感染；(6) 加强患者营养支持，提高机体抵抗力；(7) 对医护人员进行感染控制培训，提高感染防控意识。
2. 题目：请论述急性阑尾炎的诊断要点和治疗原则。
答案：急性阑尾炎的诊断要点包括：(1) 典型的转移性右下腹痛；(2) 右下腹压痛和反跳痛；(3) 可能伴有恶心、呕吐、发热等症状；(4) 血常规检查可见白细胞计数升高；(5) 影像学检查如超声或CT有助于诊断。
临床医学面试题目及答案一、个人介绍在开始面试之前，考官通常会要求你进行个人介绍。
个人介绍是展示自己的机会，你可以简要介绍自己的背景、教育经历、专业技能以及为什么选择临床医学作为职业。
在介绍时尽量保持简洁明了，突出与医学相关的经历和特长。
二、临床医学知识与技能1. 请谈谈你对临床医学的理解和认识。
答案：临床医学是运用科学和经验的原则，结合患者病情，通过临床症状、体征以及各种辅助检查结果，从而做出诊断和治疗的过程。
它既强调医生对患者的关心和悉心治疗，也强调医生对医学科学研究的深入掌握与应用。
2. 请描述一下你在临床实践中遇到的具体案例，以及你是如何处理的。
答案：在临床实践中，我遇到过一位患者出现严重呼吸困难的情况。
经过仔细观察，患者在进行呼吸运动时伴有明显的胸闷感，并且伴有气促，出汗等症状。
我立即采取了一系列应急措施，包括给予患者吸氧，监测氧饱和度，行心电图等辅助检查。
最终，我通过对患者的病史了解和临床观察，最终确诊为急性心肌梗死，并及时采取了相关治疗措施。
3. 在你的临床实习经验中，你遇到过影响你决策的困难情况吗？请描述一下，并谈谈你是如何应对的。
答案：是的，我在实习中曾遇到过一位患者病情复杂，需要进行多项检查以明确诊断。
但是，在进行检查之前，患者表现出极度抗拒情绪，害怕检查的疼痛和费用等问题。
在面对这种情况时，我首先与患者进行了深入交流，了解其顾虑和担忧，并耐心解释检查的必要性和过程。
通过与患者的沟通和理解，我最终取得了患者的合作，顺利完成了必要的检查。
三、人际交往与沟通技巧1. 在临床实践中，你如何与患者建立良好的沟通与关系？答案：与患者建立良好的沟通与关系是医生非常重要的能力之一。
我通常会采用亲切友好的语气与患者交流，并认真倾听他们的问题和疑虑。
我会尽量使用通俗易懂的语言解释医学术语，以便患者更好地理解和接受。
此外，我还注重尊重患者的隐私和权益，确保他们在医疗过程中的舒适感。
2. 请谈谈你在团队合作中的经验，并阐述你在团队中的作用。
医学研究生面试问题及答案思路： 1、这是面试的必考题目。
2、介绍内容要与个人相一致。
3、表述方式上尽量口语化。
4、要切中要害，不谈无关、无用的内容。
5、条理要清晰，层次要分明。
6、事先最好以文字的形式写好背熟。
思路：1、况对于了解应聘者的性格、观念、心态等有一定的作用，这是招聘单位问该问题的主要原因。
2、简单地罗列家庭人口。
3、宜强调温馨和睦的家庭氛围。
4、宜强调父母对自己教育的重视。
5、宜强调各位家庭成员的良好状况。
6、宜强调家庭成员对自己工作的支持。
7、宜强调自己对家庭的责任感。
思路： 1、业余爱好能在一定程度上反映应聘者的性格、观念、心态，这是招聘单位问该问题的主要原因。
2、最好不要说自己没有业余爱好。
3、不要说自己有那些庸俗的、令人感觉不好的爱好。
4、最好不要说自己仅限于读书、听音乐、上网，否则可能令面试官怀疑应聘者性格孤僻。
5、最好能有一些户外的业余爱好来“点缀”你的形象。
思路： 1、最崇拜的人能在一定程度上反映应聘者的性格、观念、心态，这是面试官问该问题的主要原因。
2、不宜说自己谁都不崇拜。
3、不宜说崇拜自己。
4、不宜说崇拜一个虚幻的、或是不知名的人。
5、不宜说崇拜一个明显具有负面形象的人。
6、所崇拜的人人最好与自己所应聘的工作能“搭”上关系。
7、最好说出自己所崇拜的人的哪些品质、哪些思想感染着自己、鼓舞着自己。
思路： 1、座右铭能在一定程度上反映应聘者的性格、观念、心态，这是面试官问这个问题的主要原因。
2、不宜说那些医引起不好联想的座右铭。
3、不宜说那些太抽象的座右铭。
4、不宜说太长的座右铭。
5、座右铭最好能反映出自己某种优秀品质。
6、参考答案——“只为成功找方法，不为失败找借口”思路： 1、不宜说自己没缺点。
2、不宜把那些明显的优点说成缺点。
3、不宜说出严重影响所应聘工作的缺点。
4、不宜说出令人不放心、不舒服的缺点。
5、可以说出一些对于所应聘工作“无关紧要”的缺点，甚至是一些表面上看是缺点，从工作的角度看却是优点的缺点.思路： 1、不宜说自己没有失败的经历。
第1篇一、开场白尊敬的面试官，您好！我是参加外科学岗位面试的应聘者[姓名]，很荣幸能够在这里与您们交流。
我对外科学有着浓厚的兴趣，并具备扎实的理论基础和丰富的实践经验。
以下是我对几个可能出现在外科学面试中的题目的解答。
二、面试题目及解答1. 请简要介绍外科学的基本概念和主要研究方向。
解答：外科学是医学科学的一个重要分支，主要研究人体外部的器官、组织、系统的疾病诊断、治疗和预防。
外科学的主要研究方向包括：创伤外科学、普通外科学、整形外科学、泌尿外科学、神经外科学、胸外科、血管外科等。
这些研究方向涵盖了人体各个系统的疾病，旨在提高人类健康水平。
2. 请谈谈您对微创外科技术的理解及其在外科学中的应用。
解答：微创外科技术是一种通过微小切口进行手术的新技术，具有创伤小、恢复快、疼痛轻、并发症少等优点。
微创外科技术在临床上的应用越来越广泛，如腹腔镜手术、胸腔镜手术、关节镜手术等。
这些技术在治疗某些疾病方面具有明显优势，如胆囊结石、阑尾炎、甲状腺疾病等。
3. 您在临床实习或工作中，遇到过哪些典型病例？请简要描述病例特点、诊断及治疗方案。
解答：在临床实习期间，我曾遇到一例急性阑尾炎病例。
患者为一名20岁男性，主诉右下腹疼痛，伴有恶心、呕吐等症状。
经过详细询问病史、体格检查和实验室检查，确诊为急性阑尾炎。
治疗方案为：抗感染治疗、保守治疗无效后，进行腹腔镜下阑尾切除术。
4. 请谈谈您对手术风险管理的认识。
解答：手术风险管理是指在外科手术过程中，对可能出现的风险进行识别、评估、预防和控制的过程。
手术风险管理包括以下几个方面：（1）术前评估：充分了解患者的病史、体检结果、实验室检查等，评估手术风险。
（2）术中监测：密切监测患者的生命体征、手术部位情况等，及时发现并处理异常情况。
（3）术后观察：术后密切观察患者的生命体征、伤口愈合情况、并发症等，及时处理术后并发症。
（4）持续改进：总结手术经验，不断完善手术流程，提高手术安全性。
第1篇一、专业知识题1. 请简要介绍内科学的研究范围和主要内容。
2. 什么是炎症？炎症的病理生理过程有哪些？3. 请列举常见的细菌感染性疾病及其治疗方法。
4. 简述慢性阻塞性肺疾病（COPD）的病因、临床表现、诊断和治疗方法。
5. 请解释高血压的定义、分类、病因和临床表现。
6. 简述糖尿病的定义、病因、临床表现、诊断和治疗方法。
7. 请介绍急性心肌梗死的病因、临床表现、诊断和治疗方法。
8. 请列举常见的传染病及其传播途径。
9. 简述恶性肿瘤的定义、病因、临床表现、诊断和治疗方法。
10. 请解释什么是呼吸衰竭？其病因、临床表现、诊断和治疗方法有哪些？二、临床技能题1. 请简要介绍心肺复苏（CPR）的操作步骤。
2. 如何进行血压测量？请描述血压计的使用方法。
3. 请演示如何进行血糖检测。
4. 如何进行体温测量？请描述体温计的使用方法。
5. 请描述如何进行脉搏测量。
6. 请演示如何进行腹部触诊。
7. 请描述如何进行肺部听诊。
8. 请描述如何进行心脏听诊。
9. 请描述如何进行神经系统检查。
10. 请描述如何进行骨折的初步处理。
三、案例分析题1. 某患者，男性，50岁，主诉：乏力、消瘦、多尿、多饮、多食。
请根据病史，初步诊断患者可能患有什么疾病？并说明诊断依据。
2. 某患者，女性，30岁，主诉：持续性胸痛，伴出汗、恶心、呕吐。
请根据病史，初步诊断患者可能患有什么疾病？并说明诊断依据。
3. 某患者，男性，70岁，主诉：呼吸困难、咳嗽、咳痰。
请根据病史，初步诊断患者可能患有什么疾病？并说明诊断依据。
4. 某患者，女性，45岁，主诉：头痛、恶心、呕吐、视力模糊。
请根据病史，初步诊断患者可能患有什么疾病？并说明诊断依据。
5. 某患者，男性，50岁，主诉：腹痛、腹泻、发热。
请根据病史，初步诊断患者可能患有什么疾病？并说明诊断依据。
四、综合素质题1. 请简要介绍自己的专业特长和兴趣爱好。
2. 在临床工作中，你认为最重要的素质是什么？为什么？3. 请谈谈你对医患关系的看法。
第1篇一、自我介绍1. 题目：请您做一个简短的自我介绍。
解析：这是一个面试的必考题目，通过自我介绍，面试官可以了解应聘者的基本信息、教育背景、工作经历等。
在回答时，应聘者应保持自信、真诚，突出自己的优势。
2. 题目：请您谈谈您的专业特长和兴趣爱好。
解析：这个问题可以帮助面试官了解应聘者的专业素养和综合素质。
在回答时，应聘者可以结合自己的专业背景，谈谈自己的研究兴趣、实践经验等，并简要介绍自己的兴趣爱好，展现自己的个性。
二、专业知识1. 题目：请您谈谈对医学伦理的理解。
解析：医学伦理是医学领域的重要部分，了解应聘者对医学伦理的认识有助于判断其职业素养。
在回答时，应聘者可以从医学伦理的定义、原则、案例分析等方面进行阐述。
2. 题目：请描述一个您在临床工作中遇到的典型病例，并说明您的处理方法。
解析：这个问题旨在考察应聘者的临床经验和解决问题的能力。
在回答时，应聘者应选择一个具有代表性的病例，阐述病例的基本情况、诊断过程、治疗措施及结果，并分析自己在其中的作用。
3. 题目：请谈谈对循证医学的理解。
解析：循证医学是医学研究的重要方法，了解应聘者对循证医学的认识有助于判断其科研能力。
在回答时，应聘者可以从循证医学的定义、原则、应用等方面进行阐述。
三、临床技能1. 题目：请描述一个您在临床工作中遇到的紧急情况，并说明您的处理方法。
解析：这个问题旨在考察应聘者的应急处理能力和临床技能。
在回答时，应聘者应选择一个具有代表性的紧急情况，阐述情况发生的背景、自己的处理方法及结果。
2. 题目：请谈谈您在临床操作中的注意事项。
解析：这个问题旨在考察应聘者的临床操作规范和责任心。
在回答时，应聘者可以从无菌操作、患者隐私保护、设备使用等方面进行阐述。
四、职业规划与发展1. 题目：您对未来5年的职业发展有什么规划？解析：这个问题旨在了解应聘者的职业目标和发展方向。
在回答时，应聘者可以从短期、中期、长期目标进行阐述，并说明为实现这些目标所做的努力。
第1篇一、个人背景与动机1. 请问您为什么选择医学专业？解答思路：可以从个人经历、兴趣爱好、家庭背景等方面回答，强调自己对医学的热情和责任感，以及对为社会健康事业做出贡献的愿望。
2. 您在本科或研究生阶段，有哪些与医学相关的实践经验？解答思路：列举实习、志愿服务、科研项目等经历，展示自己在医学领域的实践能力和专业知识。
3. 您认为自己的优势和不足有哪些？解答思路：从专业技能、沟通能力、团队合作、抗压能力等方面进行阐述，同时表明自己愿意不断学习和改进。
二、专业知识与技能1. 请简要介绍您所学的医学基础知识。
解答思路：列举医学基础课程，如解剖学、生理学、病理学等，并结合具体例子说明自己的学习成果。
2. 您在临床实习中，遇到过哪些典型的病例？如何处理？解答思路：选取具有代表性的病例，描述病例特点、诊断过程和治疗方案，展现自己的临床思维和解决问题的能力。
3. 请谈谈您对某种疾病的了解，包括病因、症状、诊断和治疗方法。
解答思路：选择一种常见疾病，从病因、症状、诊断、治疗等方面进行阐述，体现自己的医学知识储备。
三、医德与医风1. 您认为作为一名医生，最重要的品质是什么？解答思路：可以从医德、医术、责任心、同理心等方面进行回答，强调医生应具备的高尚品质。
2. 您如何看待医患关系？解答思路：阐述医患关系的重要性，强调医生应尊重患者、关爱患者，以及如何处理医患矛盾。
3. 您在实习或工作中，遇到过医德医风方面的问题吗？如何处理？解答思路：举例说明遇到的问题，并阐述自己的处理方式，体现自己的职业道德和责任感。
四、团队合作与沟通1. 您如何处理与团队成员之间的冲突？解答思路：从沟通、协商、妥协等方面进行回答，强调团队合作的重要性。
2. 请谈谈您在团队工作中的经历，以及如何发挥自己的作用。
解答思路：列举团队工作中的具体案例，展示自己的团队协作能力和领导才能。
3. 您如何与患者及其家属进行有效沟通？解答思路：从倾听、理解、尊重等方面进行回答，强调医患沟通的重要性。
第1篇一、基础知识题1. 请简述细胞膜的结构和功能。
2. 解释什么是生物氧化和呼吸链。
3. 请描述蛋白质的合成过程。
4. 介绍DNA的复制和转录过程。
5. 解释什么是酶和酶促反应。
6. 简述细胞的信号传导途径。
7. 请解释什么是免疫系统和免疫应答。
8. 介绍什么是炎症和炎症反应。
9. 解释什么是肿瘤和肿瘤的发生发展。
10. 简述心血管系统的结构和功能。
二、专业知识题1. 请简述糖尿病的临床表现、诊断和治疗方法。
2. 解释什么是高血压，并介绍其诊断标准和治疗方法。
3. 请描述呼吸系统疾病的常见症状和诊断方法。
4. 介绍消化系统疾病的常见症状和诊断方法。
5. 解释什么是肾脏疾病，并介绍其诊断和治疗方法。
6. 请描述神经系统疾病的常见症状和诊断方法。
7. 介绍妇产科疾病的常见症状和诊断方法。
8. 解释什么是传染病，并介绍其传播途径和预防措施。
9. 请描述儿科疾病的常见症状和诊断方法。
10. 介绍眼科疾病的常见症状和诊断方法。
三、病例分析题1. 患者男性，45岁，反复出现上腹部疼痛、饱胀、恶心、呕吐，查体：腹软，上腹部压痛，肝脾未触及。
请分析该患者的可能诊断和进一步检查措施。
2. 患者女性，28岁，孕2产0，停经45天，阴道少量出血，下腹痛。
查体：宫颈着色，宫体饱满，无压痛。
请分析该患者的可能诊断和进一步检查措施。
3. 患者男性，70岁，咳嗽、咳痰、气促3个月，加重1周。
查体：双肺呼吸音粗，可闻及湿啰音。
请分析该患者的可能诊断和进一步检查措施。
4. 患者女性，60岁，反复出现乏力、食欲不振、体重下降，查体：肝脾肿大，肝掌、蜘蛛痣。
请分析该患者的可能诊断和进一步检查措施。
5. 患者男性，30岁，突发胸痛，持续1小时，伴大汗、恶心。
查体：血压80/50mmHg，心率120次/分，双肺呼吸音粗，可闻及哮鸣音。
请分析该患者的可能诊断和进一步检查措施。
四、临床技能操作题1. 请演示如何进行血压测量。
2. 请演示如何进行血糖测量。
临床医学面试题目在这篇文章中，我们将介绍一些临床医学面试题目，帮助准备面试的医学生更好地应对面试。
以下是一些常见的临床医学面试题目以及对应的参考答案。
1. 你为什么选择临床医学作为你的职业？参考答案：我选择临床医学是因为我对人类健康和医疗技术非常感兴趣。
我希望能为患者提供最好的医疗服务，并缓解他们的痛苦。
我相信通过临床医学，我能够通过治疗和护理帮助改善人们的生活质量。
2. 你在临床实践中遇到的最大挑战是什么，你是如何应对的？参考答案：在临床实践中，我曾遇到一个病人的病情非常复杂，多个系统同时受到影响。
这对我来说是一个巨大的挑战，因为我需要在有限的时间内做出正确的诊断并制定治疗方案。
我当时积极与我的导师和其他同事合作，共同讨论和分析病情，最终成功地解决了这个问题。
3. 你如何处理与患者不满或抱怨的情况？参考答案：当患者对我的医疗服务表示不满或抱怨时，我首先会倾听他们的意见并表达我的理解。
然后，我会解释我所做的决策和处理方法，并确保他们理解我所做的一切都是为了他们的最佳利益。
如果有必要，我会与他们进行进一步的讨论，并尽力解决问题。
4. 你如何处理与其他医务人员的合作？参考答案：在与其他医务人员合作时，我认为沟通和团队合作是至关重要的。
我会积极倾听他们的意见和建议，并愿意分享我自己的观点和经验。
我相信只有通过相互合作和尊重，我们才能达到最好的医疗团队效果。
5. 你认为哪些品质是一个合格的临床医生应该拥有的？参考答案：一个合格的临床医生应该具备良好的沟通和人际交往能力，能够与患者和其他医务人员有效地合作。
此外，他们应该具备扎实的医学知识和技能，并能够在紧急情况下做出明智的决策。
同样重要的是，他们应该具备同理心和耐心，能够关注患者的整体健康状况。
本文介绍了一些常见的临床医学面试题目以及对应的参考答案。
在面试准备过程中，希望这些问题和答案能够帮助你更好地应对临床医学面试，展现自己的优势和能力。
记住，面试是一个展示自己的机会，所以要保持自信和专业，应对问题时要清晰明了、结构严谨，并且充分展示你的医学知识和技能。
343D iseases of the C olon & R eCtum V olume 56: 3 (2013)BACKGROUND: ligation of intersphincteric fistulatract is a novel surgical technique in the treatment of transsphincteric fistula-in-ano that has been shown to be successful in the short term. median follow-up in current literature ranges from 5 to 9 months. however, the long-term success rate is unknown.OBJECTIVE: this study describes our long-term resultsin performing the ligation of intersphincteric fistula tract procedure.DESIGN: this study is a retrospective review.PATIENTS: thirty-eight patients from august 2008 tooctober 2011 were evaluated.INTERVENTIONS: all patients underwent the ligation ofintersphincteric fistula tract for fistula-in-ano.MAIN OUTCOME MEASURES: Patient and fistulacharacteristics, primary healing rate, secondary healing rate, previous treatments, and failures were reviewed.RESULTS: the median follow-up was 26 months (range,3–44 months), and 26 patients (68%) were followed for greater than 12 months. the overall primary healing rate was 61% (23 of 38), and it was 62% (16 of 26) in patients followed for over 12 months. eighty percent (12/15) of the failures are early failures (persistent symptoms or failure at ≤6 months), and 20% are late failures (>6 months) with 1 failure occurring 12 months postprocedure. increase in length of fistula tract wasassociated with decreased healing (oR 0.55, 95% Ci 0.34–0.88, p = 0.01). there were no intraoperative complications and no reported incontinence.CONCLUSION: our study demonstrates favorable long-term results for the ligation of intersphincteric fistula tract procedure. it appears that long tracts negativelyaffect healing, and late failures can occur up to 12 months postoperatively. understanding the type of failure can help guide subsequent treatment to maximize healing success.KEY WORDS: fistula-in-ano; ligation of intersphinctericfistula tract; long-term; failure type; Durability; fistula tract length.ligation of intersphincteric fistula tract (lift) is a novel surgical technique described by Rojanasakul et al 1 in the treatment of transsphincteric fistula-in-ano. it has been shown to be successful in the short term with no reported incontinence. We have previously reported a primary healing rate of 68%, which is comparable to healing rates of 57% to 94% at other institutions.1–8 Currently published median follow-up ranges from 5 to 9 months,1–8 but several authors have found that late recurrences can occur 7 to 8 months after surgery.4,6 thus, the short-term success rates described may be an overestimate of the true success rate. extended follow-up is needed to better understand the long-term outcome of lift. the current study reports our long-term experience.MATERIALS AND METHODSa retrospective analysis was performed on all patients who underwent the lift procedure from august 2008 to oc-tober 2011, at harbor-uCla medical Center, a university-affiliated los angeles County institution. the study was approved by the institutional review board at the los an-Long-term Results of Ligation of Intersphincteric Fistula Tract (LIFT) for Fistula-in-AnoWendy Y. liu, m.D.1 • armen aboulian, m.D.2 • amy h. Kaji, m.D., Ph.D.1 Ravin R. Kumar, m.D.11 harbor-uCla medical Center, Division of Colon and Rectal surgery, torrance, California2 Cleveland Clinic foundation, Department of Colorectal surgery, Cleveland, ohioDis Colon Rectum 2013; 56: 343–347Doi: 10.1097/DCR.0b013e318278164c © the asCRs 2013Financial Disclosures: none reported.Podium presentation at the meeting of the american society for Colon and Rectal surgeons, san antonio, texas, June 2 to 6, 2012.Correspondence: Ravin R. Kumar, m.D., Division of Colon and Rectal surgery, harbor-uCla medical Center, 1000 West Carson st, Box 25, torrance, California 90502. e-mail: rkumar@ ORIGINAL CONTRIBUTIONl iu et al:l onG-teRm R esults of the lift P RoCeDuRe 344geles Biomedical institute of harbor-uCla medical Cen-ter. all patients had transsphincteric fistula-in-ano that was not amenable to fistulotomy because of significant ex-ternal sphincter involvement and the risk of incontinence.a single surgeon experienced with the lift procedure performed all of the operations.the lift procedure is performed as described in our previous publication.5 Patients received preoperative bowel preparation with sodium phosphate enema. the procedure is performed with the patient in the prone jackknife posi-tion under general or regional anesthesia, with appropriate preoperative antibiotics. after confirming that there is no active sepsis or abscess, the fistula tract is delineated by us-ing a probe or hydrogen peroxide injection. the length of the tract is recorded as the direct linear distance between the external skin opening and the anal verge. then, a pedi-atric feeding tube and/or a lacrimal duct probe is placed in the fistula tract. a curvilinear skin incision is made directly over the intersphincteric groove to enter the intersphinc-teric space. With the external sphincter retracted laterally, the fistula tract is dissected, isolated, and divided just lat-eral to the internal sphincter. exposure is attained with lift retractors courtesy of Dr Rojanasakul or s retractors.a small segment of the intersphincteric tract is excised. the medial stump of the tract site was closed over the internal sphincter muscle by using absorbable sutures in a figure-of-8 fashion. the lateral tract opening in the intersphinc-teric space is closed over the external sphincter muscle with absorbable sutures. satisfactory closure is confirmed by injecting hydrogen peroxide from the external skin open-ing. the external tract is cleared by using a curette and/ or cautery, and the skin opening is widened and left open for drainage. the primary mucosal internal opening within the anal canal is closed using a figure-of-8 stitch. the in-tersphincteric space is irrigated and closed with absorbable sutures in layers.the majority of the patients had seton placed for 4 to 8 weeks before the lift procedure. others underwent lift as the primary procedure, and the fistula tract is well delineated with no underlying significant sepsis at the time of surgery. all procedures took place in an outpatient set-ting. Patients were discharged with instructions for 1 week of oral metronidazole, stool softener, bulking agents, sitz bath, and pain medication. follow-up was scheduled at 1, 2, 6 weeks, 3 months, 6 months, and 12 months after sur-gery. at each visit, patients were asked to report any sub-jective change in continence to gas, liquid, or solid stool.Primary healing is defined as complete healing of both the external opening and intersphincteric incision with complete resolution of symptoms, without addition-al interventions. We categorized patients with persistent symptoms or reappearance of symptoms before 6 months as early failures. late failures are those with resolution of symptoms in the early period but return of symptoms after 6 months. Patients who healed completely were con-tacted every 6 months thereafter to assess for any recur-rence of symptoms. Patients with persistent symptoms were initially managed conservatively unless there was significant sepsis requiring early intervention. examina-tion under anesthesia was planned if symptoms worsen or continue to persist after 6 months. the anatomical features of failures were determined during examination under anesthesia using probes and hydrogen peroxide in-jection. similarly to the report by tan et al,6we classified failures into 3 types. type i failures represented residual sinus tracts without an internal opening. type ii failures represented a downstaged tract from the intersphincteric incision to the internal opening. type iii failures are com-plete failures that extend from previous internal opening to one or more external skin openings.statistical analysis was performed by using sas v 9.2 (sas institute, Cary, nC). Results were expressed as me-dians with interquartile ranges for continuous variables. Wilcoxon tests were performed to assess for significant differences between groups that healed vs those that did not. When categorical variables were compared, the χ2 or fisher exact tests were performed, as appropriate. the Ka-plan-meier method was used to perform a survival analy-sis, which demonstrates the durability of success after the lift procedure over time (fig. 1). subjects were censored at the last follow-up date. the index date, or first day of the survival period, was the date of the operation. RESULTSthirty-nine lift procedures were performed on 38 patients by a single surgeon (table 1). the patients consist of 28 men (74%) and 10 women (26%), with a median age of 42 years and median symptom duration of 24 months (range, 2–72 months). median follow-up was 26 months (range, 3–44 months), and 26 patients (68%) had follow-up exceeding 12 months. Previous definitive fistula repairs (fistula plug, fibrin glue, or mucosal advancement flap) had failed in 7 patients (18%). twenty-nine patients (76%) RateofsuccessRate of success0.10.20.30.40.50.60.70.80.93691215Months of follow-upFIGURE 1. Durability of LIFT over time. LIFT = ligation of intersphincteric fistula tract.D iseases of the C olon &R eCtum V olume 56: 3 (2013)345had a seton before their lift procedure. five patients had posterior midline fistulas and/or a history of horseshoe abscesses. the median fistula tract length was 4 cm (range, 2–10 cm) with 66% having tract length longer than 3 cm.of the 38 patients, 23 (61%) healed after the initial lift procedure without the need for further interventions (table 2). in patients followed for more than 12 months, the primary healing rate is 62% (16/26). figure 1 shows the durability of lift procedure success over time. of the patients who healed primarily, median time to healing was 8 weeks (range, 4–36 weeks). When looking at the im-pact of fistula length on primary healing, our data showed that for every 1 cm increase in fistula length, the oR for healing decreases by 0.55 (95% Ci 0.34–0.88, p = 0.01) (table 3). the median length of fistula tract is shorter in the healed group compared with the failed group (4 cm vs 6 cm, p= 0.004) (table 4). When choosing 3 cm as an arbitrary cutoff point, fistula tracts less than 3 cm had sig-nificantly higher primary healing (85% vs 48%, p = 0.04) (table 3). the healing rates for patients with and without previous seton are 62% (18/29) and 56% (5/9), with an oR of 1.3 (95% Ci 0.3–5.9, p = 1.0). the healing rates for patients with and without previous fistula procedures are 71% (5/7) and 58% (18/31), with an oR of 2.3 (95% Ci 0.4–13.3, p = 0.4). additionally, age, sex, comorbidities, and symptom duration have no statistically significant in-fluence on healing (table 4).When looking at the 15 patients in whom treatment failed, the median time to failure was 4 months, and, in 1 patient, failure occurred 12 months post-lift. eighty percent (12/15) of the failures are early failures (persistent symptoms or failure at ≤6 months), and 20% (3/15) are late failures (>6 months). of the 15 total failures, 3 were type i, 1 was type ii, and 9 were type iii (fig. 2). two additional patients with failures are awaiting evaluation. of the 3 patients with type i failure, 2 healed after curettage and 1 is pending after drain placement. the type ii patient, who had downstaged to an intersphincteric fistula, healed after intersphincteric fistulotomy. of the 9 patients with type iii failures, 5 had single external skin openings and 4 had multiple external skin openings. in the single skin opening group, one healed after repeat lift (explaining 39 lift procedures on 38 patients), 1 healed after fistula plug, 1 is recovering from a second fistula plug, and 2 patients are pending further treatments. in the group with multiple skin openings, 1 healed after fistulotomy/curettage, 1 experienced failure after fistula plug, and 2 are pending after cutting seton/fistulotomy.no subjective incontinence was reported, and no in-traoperative complication occurred. two patients had vaginal fungal infection postoperatively and recovered uneventfully with topical cream treatment. DISCUSSIONlift is a novel procedure that several studies have shown to have good short-term success in the treatment of transsphincteric fistula-in-ano.1–8 this study shows a primary healing rate of 62% after 12 months with minimal risk of incontinence. additionally, we found the range of healing time to be from 4 to 36 weeks after surgery. therefore, in patients with persistent symptoms, it may be prudent to observe and manage symptoms with local care up to 6 months or more before planning for additional treatment. this could potentially avoidTABLE 1.Demographic and clinical dataTotal number of patients38Total LIFT procedures39Sex, % male74 (n = 28) Median age, y (range)42 (26–58) Median symptom duration, mo (range)24 (2–72) Previous setons, %76 (n = 29) Previous definitive fistula operations, %18 (n = 7) LIFT as first procedure, %18 (n = 7) Median fistula tract length, cm (range) 4 (2–10) Fistula tract length ≤3 cm, %34 (n = 13) Fistula tract length >3 cm, %66 (n = 25) Posterior midline or history of horseshoe abscess, %13 (n = 5) ComorbiditiesHIV1History of diverticulitis1Hyperlipidemia2Diabetes mellitus5Hypertension5 LIFT = ligation of intersphincteric fistula tract.TABLE 2.Overall results (total n = 38)Primary healing, %61 (n = 23/38) Primary healing after 12 mo, %62 (n = 16/26) Median follow-up, mo (range)26 (3–44)Follow-up exceeding 12 mo, % patients68 (n = 26) Median healing time, wk (range)8 (4–36)Healing in posterior midline fistulas or historyof horseshoe abscess, %60 (n = 3/5)Median time to failure, mo (range) 4 (persistentsymptoms-12) Early failures (≤6 mo), %80 (n = 12/15) Late failures (>6 mo), %20 (n = 3/15) Incontinence, %0TABLE 3.Effect of fistula length on healing rateHealing rate, (%)Difference Fistula tract length ≤3 cm85 (n = 11/13)p = 0.04Fistula tract length >3 cm48 (n = 12/25)Effect of length of fistula tracton healingNA OR 0.55 (95%CI0.34–0.88),p = 0.01 NA = not applicable.l iu et al:l onG-teRm R esults of the lift P RoCeDuRe 346some unnecessary operations. of course, some patients may require earlier intervention if their symptoms worsen or they develop significant sepsis. We also found that, although the majority of lift failures present early, some occur beyond 6 months and as late as 12 months after the initial procedure. therefore, we suggest extended follow-up of at least 12 months after initial surgery to be certain that complete healing has occurred.lift failures can be multidimensional. identifying the type of failure can help direct subsequent therapy. some recommend the routine adoption of endorectal ul-trasound to evaluate all suspected failures.6 in our series,TABLE parison of healed and failed groupHealed group (n = 23)Failure group(n = 15)DifferenceSex, male16/23 (69.6%)12/15(80.0%)χ2 = 0.5,Fisher exactp = 0.7 Age, median (IQR)42 (35–51)42 (39–46)Wilcoxonp = 0.7 Symptom duration, mo, median (IQR)24 (12–28)24 (13–48)Wilcoxonp = 0.4 Fistula length, cm, median (IQR) 4 (3–4) 6 (4–6)Wilcoxonp = 0.004 Fistula tract length ≤3 cm11/23 (47.8%)2/15 (13.3%)χ2 = 4.7,Fisher exactp = 0.04 Any comorbidities9/23 (39.1%)5/15 (33.3%)χ2 = 0.1,Fisher exactp = 1.0 IQR = interquartile range.FIGURE 2. Patterns of failures after initial LIFT procedure and outcome. LIFT = ligation of intersphincteric fistula tract.D iseases of the C olon &R eCtum V olume 56: 3 (2013)347we were able to demonstrate the types of failure with in-traoperative evaluation by using probes and injection of hydrogen peroxide. We feel that the ultrasound or other imaging modalities could be reserved for select failures with complex tracts not demonstrable by intraoperative evaluation. Potentially one of the greatest advantages of the lift procedure is that, in some cases, it converts a complex, difficult-to-treat fistula to a more manageable one with minimal risk of sphincter injury. type i failures can be managed with curettage of the tract, silver nitrate applications and short-term antibiotics, and local incision and drainage for underlying sepsis. type ii failures can be managed with simple or staged intersphincteric fistuloto-my. type iii failures can be managed with a cutting seton followed by plans for a repeat definitive fistula procedure such as lift, fistula plug, or mucosal advancement flap.mcG ee and colleagues9 have found that fistula tract length longer than 4 cm predicts improved healing with anal fistula plugs. this may be due to a longer tract provid-ing a better scaffolding for the plug, which decreases plug dislodgment. to our knowledge, in the current lift liter-ature, there is no description of an association between fis-tula tract length and healing. in our series, we found that longer fistula tracts correlate with a lower primary healing rate. one caveat is that our method for measuring tract length may not be as accurate for patients with curved tracts. nevertheless, we believe that the reason for this ob-served correlation is that the lift procedure eliminates the communication and a portion of the intersphincteric tract between the internal and external openings. there-fore, longer tract length should not in theory promote im-proved healing with the lift procedure. in fact, longer tract may potentially be more prone to having persistent epithelial tissue, inflammation, and sepsis, making healing more difficult. in our series, 2 of the type i failures with persistent sinus tract healed after local care with curettage and cauterization of the tract. We postulate that thorough curettage, cauterization, and peroxide irrigation of the ex-ternal tract at the initial operation and widening of the external opening to facilitate drainage may minimize per-sistent sepsis and improve healing.our study represents one of the longest follow-up se-ries to date, with a median follow-up of 26 months and 68% of the patients followed for more than 1 year. fur-thermore, all procedures were performed by a single expe-rienced surgeon, which eliminates the variation in surgeon technique as a potential confounding factor. the primary weakness of this study is that it is a retrospective single-institution study with small sample size. it lacks adequate power to detect any potential effect on healing by the pres-ence of previous fistula procedures, setons, and patient preoperative characteristics. there is also an element of selection bias by the surgeon. the surgeon may opt not to perform the lift procedure if the fistula tract is difficult to delineate because of body habitus or difficult anatomic location such as posterior midline/horseshoe tracts. an-other weakness of the study is that continence was sub-jectively evaluated on the basis of the patient’s opinion. the use of a formal continence scale would yield more ac-curate results. larger, long-term prospective randomized controlled studies are needed to validate the true success rate of lift and to identify disease characteristics that can assist in better patient selection to achieve better outcome. 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