Williams J G, Rothenberger D A, Nemer F D, Goldberg S M
Division of Colon and Rectal Surgery, University of Minnesota, Minneapolis 55455.
Dis Colon Rectum. 1991 May;34(5):378-84. doi: 10.1007/BF02053687.
The outcome of aggressive surgical treatment of 64 symptomatic anal fistulas in 55 patients with Crohn's disease has been studied. Forty-one fistulas, in 33 patients, were treated by conventional fistulotomy (17 subcutaneous, 19 intersphincteric, 5 low transsphincteric fistulas). Thirty wounds (73 percent) healed within 3 months and eight more wounds (93 percent) healed within 6 months. Three wounds did not heal within 12-18 months. Two of these patients subsequently required proctocolectomy. Wound healing was not influenced by the presence of rectal Crohn's disease or granulomatous inflammation in the tract. No change in continence was experienced by 26 of the 33 patients who underwent fistulotomy. Three patients required proctocolectomy and the remaining four patients experienced minor degrees of incontinence postoperatively. Sixteen high transsphincteric, five suprasphincteric, and one extrasphincteric fistula in 22 patients were treated by laying open external tracts and placing a noncutting seton through the sphincter, which was left in place for prolonged periods to maintain drainage. During follow-up (6 months to 10 years, median 2.5 years), three fistulas healed and seven remained quiescent. Nine patients required further treatment by a new seton and three patients required proctocolectomy. Eight of the 22 patients who had a seton inserted had no change in continence, and six patients in this group developed minor changes in continence, mostly related to diarrhea associated with intestinal disease. Anal fistulas in Crohn's disease, which involve minimal sphincter muscle, can be successfully treated by fistulotomy. High fistulas should be treated with seton drainage to limit recurrent suppuration and preserve sphincter function.
对55例克罗恩病患者的64个有症状肛瘘进行积极手术治疗的结果进行了研究。33例患者的41个肛瘘接受了传统肛瘘切开术（17个皮下肛瘘、19个括约肌间肛瘘、5个低位经括约肌肛瘘）。30个伤口（73%）在3个月内愈合，另外8个伤口（93%）在6个月内愈合。3个伤口在12 - 18个月内未愈合。其中2例患者随后需要行直肠结肠切除术。伤口愈合不受直肠克罗恩病或瘘管内肉芽肿性炎症的影响。33例行肛瘘切开术的患者中，26例控便功能无变化。3例患者需要行直肠结肠切除术，其余4例患者术后出现轻度失禁。22例患者的16个高位经括约肌肛瘘、5个括约肌上肛瘘和1个括约肌外肛瘘，采用开放外瘘管并通过括约肌放置非切割挂线治疗，挂线长期留置以保持引流。在随访期间（6个月至10年，中位时间2.5年），3个肛瘘愈合，7个保持静止。9例患者需要重新放置挂线进一步治疗，3例患者需要行直肠结肠切除术。22例放置挂线的患者中，8例控便功能无变化，该组6例患者控便功能出现轻度变化，主要与肠道疾病相关的腹泻有关。克罗恩病肛瘘若涉及的括约肌肌肉最少，可通过肛瘘切开术成功治疗。高位肛瘘应采用挂线引流治疗，以限制反复化脓并保留括约肌功能。
