Yamamoto T, Allan R N, Keighley M R
University Department of Surgery, Queen Elizabeth Hospital, Edgbaston, Birmingham, UK.
World J Surg. 2000 Oct;24(10):1258-62; discussion 1262-3. doi: 10.1007/s002680010250.
The role of fecal diversion alone for perianal Crohn's disease remains unclear. This study was undertaken to assess its role in perianal Crohn's disease and to examine predictive factors for outcome. Thirty-one patients who underwent fecal diversion alone for perianal Crohn's disease between 1970 and 1997 were reviewed. The principal indications for fecal diversion were severe perianal sepsis in 13 patients, recurrent deep anal ulcer in 3, complex anorectal fistula in 9, and rectovaginal fistula in 6. Twenty-five patients (81%) went into early remission, and six (19%) failed to respond. Of the 25 early responders, 17 relapsed at a median duration of 23 months after fecal diversion. By contrast, 8 patients (26%) went into complete remission and required no further surgery at a median duration of 81 months after the diversion. Altogether, 22 patients required surgery at a median duration of 20 months after fecal diversion: proctectomy in 21 and repeated drainage of anal sepsis in 1. At present, intestinal continuity has been restored in only three patients (10%). The following parameters were compared in patients with and without complete remission after fecal diversion: age, gender, duration of disease, steroid use, smoking, coexisting Crohn's disease, preoperative blood indices, and Crohn's disease activity index. None of these parameters affected the outcome. In conclusion, fecal diversion alone is effective in selected patients with perianal disease, but the prospect of restoring intestinal continuity is low. There were no parameters to identify those in whom a successful outcome is likely.
单纯粪便转流术在肛周克罗恩病中的作用仍不明确。本研究旨在评估其在肛周克罗恩病中的作用，并探讨预后的预测因素。回顾了1970年至1997年间仅因肛周克罗恩病接受粪便转流术的31例患者。粪便转流术的主要适应证为：13例严重肛周脓毒症、3例复发性深部肛管溃疡、9例复杂性肛肠瘘和6例直肠阴道瘘。25例患者（81%）实现早期缓解，6例（19%）无反应。在25例早期缓解者中，17例在粪便转流术后中位23个月复发。相比之下，8例患者（26%）实现完全缓解，在转流术后中位81个月无需进一步手术。总共22例患者在粪便转流术后中位20个月需要手术：21例行直肠切除术，1例行肛管脓毒症反复引流术。目前，仅3例患者（10%）恢复了肠道连续性。比较了粪便转流术后完全缓解和未完全缓解患者的以下参数：年龄、性别、病程、类固醇使用情况、吸烟情况、并存的克罗恩病、术前血液指标和克罗恩病活动指数。这些参数均未影响预后。总之，单纯粪便转流术对部分肛周疾病患者有效，但恢复肠道连续性的前景较低。没有参数可用于识别可能获得成功预后的患者。
