Fry R D, Shemesh E I, Kodner I J, Timmcke A
Department of Surgery, Jewish Hospital, St. Louis, Missouri 63110.
Surg Gynecol Obstet. 1989 Jan;168(1):42-8.
We reviewed our experience with 73 patients who had Crohn's disease and underwent local anorectal surgical procedures for perianal suppurative disease during a ten year period. All but one of these patients had intestinal granulomatous disease. The average length of follow-up study was 4.6 years. By using conservative, local anorectal surgical procedures and intensive medical treatment, we were able to establish adequate drainage of abscesses, reduce the inflammatory process and relieve symptoms. Extensive drainage procedures were avoided to preserve the anal sphincter. A sliding endorectal flap repair provided satisfactory results for rectovaginal fistulas and anterior anal fistulas. Proctectomy was eventually necessary in nine patients, the primary indication being severe perianal disease in five. By performing complete excision of the perineal disease at the time of proctectomy, we were able to achieve primary healing of the perineal wound in eight of these patients. Patients were classified according to five categories of results: healed after initial local treatment, eight patients; healed after more than one local treatment, 30 patients; incomplete healing with acceptable condition, 17 patients; healed after fecal diversion, nine patients, and required proctectomy, nine patients. The majority of patients with Crohn's disease and anal and perianal suppurative disease can be managed by meticulous drainage of sepsis and preservation of the anal sphincter.
我们回顾了73例克罗恩病患者的治疗经验，这些患者在十年间因肛周化脓性疾病接受了局部肛肠外科手术。除1例患者外，所有这些患者均患有肠道肉芽肿性疾病。随访研究的平均时长为4.6年。通过采用保守的局部肛肠外科手术及强化药物治疗，我们得以实现脓肿的充分引流，减轻炎症反应并缓解症状。为保留肛门括约肌，避免了广泛的引流手术。滑动式直肠内瓣修补术对直肠阴道瘘和前位肛瘘取得了满意的效果。最终有9例患者需要行直肠切除术，主要指征是5例患者存在严重的肛周疾病。通过在直肠切除术时完全切除会阴疾病，我们使其中8例患者的会阴伤口实现了一期愈合。患者根据五类结果进行分类：初始局部治疗后痊愈，8例患者；经过不止一次局部治疗后痊愈，30例患者；愈合不完全但状况尚可，17例患者；粪便转流术后痊愈，9例患者，以及需要行直肠切除术，9例患者。大多数患有克罗恩病及肛门和肛周化脓性疾病的患者可通过精心的脓毒症引流及肛门括约肌保留来进行治疗。
