Gingold Daniel S, Murrell Zuri A, Fleshner Phillip R
From the Division of Colon and Rectal Surgery, Cedars-Sinai Medical Center, Los Angeles, CA.
Ann Surg. 2014 Dec;260(6):1057-61. doi: 10.1097/SLA.0000000000000479.
To evaluate 2- and 12-month outcomes after ligation of the intersphincteric fistula tract (LIFT) in Crohn's disease (CD).
Surgical approaches to perianal fistulas in CD are frequently ineffective and hampered by concerns over adequate wound healing and sphincter injury. The efficacy of LIFT in CD patients is unknown.
Consecutive cases of CD patients with transsphincteric fistulas were prospectively analyzed. Fistula healing and 2 validated quality-of-life indices were assessed.
Fifteen CD patients (9 women; mean age = 34.8 years) were identified. Location of the fistula was lateral (n = 10; 67%) or midline (n = 5; 33%). LIFT site healing was seen in 9 patients (60%) at 2-month follow-up. No patient developed fecal incontinence. LIFT site healing was seen in 8 of the 12 patients (67%) with complete 12-month follow-up. Significant factors for long-term LIFT site healing were lateral versus midline location (P = 0.02) and longer mean fistula length (P = 0.02). Patients who had successful operations significantly improved both their mean Wexner Perianal Crohn's Disease Activity Index and McMaster Perianal Crohn's Disease Activity Index quality-of-life scores at 2-month follow-up (14.0-3.8, P = 0.001, and 10.4-1.8, P = 0.0001, respectively).
CD-associated anal fistulas may be treated with LIFT. This surgical procedure is a safe, outpatient procedure that minimizes both perianal wound creation and sphincter injury.
评估克罗恩病（CD）患者行括约肌间瘘管结扎术（LIFT）后2个月和12个月的疗效。
CD患者肛周瘘管的手术方法常常无效，且因担心伤口愈合不佳和括约肌损伤而受到阻碍。LIFT在CD患者中的疗效尚不清楚。
对连续性CD患者经括约肌瘘管病例进行前瞻性分析。评估瘘管愈合情况和2个经过验证的生活质量指标。
共纳入15例CD患者（9例女性；平均年龄=34.8岁）。瘘管位于外侧的有10例（67%），位于中线的有5例（33%）。2个月随访时，9例患者（60%）LIFT部位愈合。无患者发生大便失禁。12例患者完成12个月随访，其中8例（67%）LIFT部位愈合。长期LIFT部位愈合的显著因素是瘘管位于外侧与中线位置（P=0.02）以及平均瘘管长度较长（P=0.02）。手术成功的患者在2个月随访时，其平均韦克斯纳肛周克罗恩病活动指数和麦克马斯特肛周克罗恩病活动指数生活质量评分均显著改善（分别从14.0降至3.8，P=0.001；从10.4降至1.8，P=0.0001）。
CD相关的肛瘘可用LIFT治疗。该手术是一种安全的门诊手术，可将肛周伤口的形成和括约肌损伤降至最低。
