Division of Colon and Rectal Surgery, University of Illinois at Chicago, 840 S Wood St, Suite 376-CSN, Chicago, IL, 60612, USA.
Department of Surgery, University of Illinois at Chicago, Chicago, IL, USA.
Tech Coloproctol. 2017 Jun;21(6):425-432. doi: 10.1007/s10151-017-1645-5. Epub 2017 Jun 15.
Anal fistulas continue to be a problem for patients and surgeons alike despite scientific advances. While patient and anatomical characteristics are important to surgeons who are evaluating patients with anal fistulas, their development and persistence likely involves a multifaceted interaction of histological, microbiological, and molecular factors. Histological studies have shown that anal fistulas are variably epithelialized and are surrounded by dense collagen tissue with pockets of inflammatory cells. Yet, it remains unknown if or how histological differences impact fistula healing. The presence of a perianal abscess that contains gut flora commonly leads to the development of anal fistula. This implies a microbiological component, but bacteria are infrequently found in chronic fistulas. Recent work has shown an increased expression of proinflammatory cytokines and epithelial to mesenchymal cell transition in both cryptoglandular and Crohn's perianal fistulas. This suggests that molecular mechanisms may also play a role in both fistula development and persistence. The aim of this study was to examine the histological, microbiological, molecular, and host factors that contribute to the development and persistence of anal fistulas.
尽管科学取得了进步，但肛门瘘管仍然是患者和外科医生共同面临的问题。虽然患者和解剖学特征对于评估肛门瘘管患者的外科医生很重要，但它们的发展和持续存在可能涉及组织学、微生物学和分子因素的多方面相互作用。组织学研究表明，肛门瘘管具有不同程度的上皮化，周围是密集的胶原组织，伴有炎症细胞的囊袋。然而，目前尚不清楚组织学差异是否或如何影响瘘管愈合。含有肠道菌群的肛周脓肿的存在通常会导致肛门瘘管的形成。这暗示了微生物成分的存在，但在慢性瘘管中很少发现细菌。最近的研究表明，在隐窝腺和克罗恩病肛周瘘管中，促炎细胞因子和上皮到间充质细胞转化的表达增加。这表明分子机制也可能在瘘管的发展和持续存在中发挥作用。本研究旨在探讨导致肛门瘘管发展和持续存在的组织学、微生物学、分子和宿主因素。
