Göttgens K W A, Smeets R R, Stassen L P S, Beets G L, Pierik M, Breukink S O
Department of Surgery and Colorectal Surgery, Maastricht University Medical Center, Post box 5800, 6202 AZ, Maastricht, The Netherlands,
Tech Coloproctol. 2015 Aug;19(8):455-9. doi: 10.1007/s10151-015-1311-8. Epub 2015 May 15.
Healing rates after surgical closure for high perianal fistula in patients with Crohn's disease are even more disappointing than in patients with cryptoglandular fistulas. The objective was to improve healing rates by combining the well-known mucosal advancement flap with platelet-rich plasma.
A prospective pilot study was conducted in one tertiary referral centre. Consecutive patients with primary or recurrent Crohn's disease-related high perianal fistulas, defined as involving the middle and/or upper third parts of the anal sphincter complex, were included. A staged procedure was performed with non-cutting seton treatment for 3 months first, followed by a mucosal advancement flap with injection of platelet-rich plasma into the fistula tract.
Ten consecutive patients were operated on between 2009 and 2014. Half (50%) of the patients had undergone previous fistula surgery. Mean follow-up was 23.3 months (SD 13.0). Healing of the fistula was 70% (95% confidence interval, 33-89%) at 1 year. One (10%) patient had a recurrence, and in two (20%) patients, the fistula was persistent after treatment. An abscess occurred in one (10%) patient. The median post-operative Vaizey score was 8.0 (range 0-21), indicating a moderate to severe continence impairment.
The results of combining the mucosal advancement flap with platelet-rich plasma in patients with Crohn's disease-related high perianal fistulas are moderate with a healing rate of 70%. Further investigation is needed to determine the benefits and risks on continence status for this technique in this patient population.
克罗恩病患者高位肛瘘手术闭合后的愈合率甚至比隐窝腺性肛瘘患者更令人失望。目的是通过将著名的黏膜推进皮瓣与富血小板血浆相结合来提高愈合率。
在一家三级转诊中心进行了一项前瞻性试点研究。纳入连续的原发性或复发性克罗恩病相关高位肛瘘患者，定义为累及肛门括约肌复合体中上部或上部三分之一部分。首先进行为期3个月的非切割挂线治疗，然后进行黏膜推进皮瓣，并将富血小板血浆注入瘘管。
2009年至2014年间连续10例患者接受了手术。一半（50%）的患者曾接受过肛瘘手术。平均随访时间为23.3个月（标准差13.0）。1年时瘘管愈合率为70%（95%置信区间，33 - 89%）。1例（10%）患者复发，2例（20%）患者治疗后瘘管持续存在。1例（10%）患者发生脓肿。术后Vaizey评分中位数为8.0（范围0 - 21），表明存在中度至重度控便功能障碍。
在克罗恩病相关高位肛瘘患者中，将黏膜推进皮瓣与富血小板血浆相结合的结果中等，愈合率为70%。需要进一步研究以确定该技术对该患者群体控便状态的益处和风险。
