Fistula Research Unit, St. Mark's Hospital and Academic Institute, Harrow, Middlesex, United Kingdom.
Department of Surgery and Cancer, Imperial College, St. Mary's Hospital, London, United Kingdom.
Dis Colon Rectum. 2019 Mar;62(3):327-332. doi: 10.1097/DCR.0000000000001271.
The characteristics of patients who develop a fistula-in-ano after an anorectal abscess are unclear.
Our study explored this relationship and patient factors associated with fistula development.
International Classification of Diseases, 10 Revision, and Classification of Interventions and Procedures, version 4, codes were used to identify all of the patients with a primary anorectal abscess. Multivariable analysis was used to identify factors predictive of fistula formation.
The study was conducted in a district general hospital.
Patients with anorectal abscess who were admitted to our institution (2004-2015) were included.
The rate of subsequent fistula formation was measured.
A total of 1970 abscess patients were identified; 70.0% (n = 1379) were men, and 7.3% (n = 144) had Crohn's disease. Fistulas occurred in 16.2% (n = 319) at a median of 7 months (interquartile range, 3-7 mo). Patients with Crohn's disease were more than twice as likely to develop a fistula than patients without Crohn's disease (32.6% vs 14.9%; OR = 2.5 (95% CI, 1.7-3.7); p < 0.001). Patients with Crohn's disease with a fistula were more likely to be women (55.3% vs 34.6%; p = 0.007) and aged <30 years (51.1% vs 24.3%; p< 0.001) versus patients without Crohn's disease with a fistula. At multivariable analysis of the entire cohort, male sex (OR = 0.7 (95% CI, 0.5-0.9); p = 0.005) and diabetes mellitus (OR = 0.5 (95% CI, 0.3-0.9); p = 0.027) were associated with a reduced likelihood of developing a fistula after abscess formation.
The study was limited by its single-center scope, retrospective analysis, and lack of a standardized definition for Crohn's disease.
Abscesses are more common in men, but progression to fistula is more likely in women. The rate of fistula progression in Crohn's disease is twice that in patients without Crohn's disease. Identification of patients at risk may help delineate those who will benefit from a more conservative surgical approach, enhanced follow-up, or investigation after abscess drainage. See Video Abstract at http://links.lww.com/DCR/A798.
肛直肠脓肿患者中形成肛瘘的特征尚不清楚。
本研究探讨了这种关系以及与瘘管形成相关的患者因素。
使用国际疾病分类第 10 次修订版和操作分类第 4 版代码确定所有原发性肛直肠脓肿患者。采用多变量分析确定预测瘘管形成的因素。
研究在一家地区综合医院进行。
纳入我院收治的肛直肠脓肿患者（2004-2015 年）。
测量后续瘘管形成的发生率。
共确定了 1970 例脓肿患者；70.0%（n=1379）为男性，7.3%（n=144）患有克罗恩病。中位数为 7 个月（四分位间距，3-7 mo）时，16.2%（n=319）发生瘘管。患有克罗恩病的患者发生瘘管的可能性是没有克罗恩病的患者的两倍多（32.6%比 14.9%；OR=2.5（95%CI，1.7-3.7）；p<0.001）。患有克罗恩病且发生瘘管的患者更有可能为女性（55.3%比 34.6%；p=0.007）和年龄<30 岁（51.1%比 24.3%；p<0.001），而没有克罗恩病且发生瘘管的患者则不是。在整个队列的多变量分析中，男性（OR=0.7（95%CI，0.5-0.9）；p=0.005）和糖尿病（OR=0.5（95%CI，0.3-0.9）；p=0.027）与脓肿形成后发生瘘管的可能性降低相关。
该研究受到单中心范围、回顾性分析以及缺乏克罗恩病标准化定义的限制。
脓肿更常见于男性，但女性更易发展为瘘管。克罗恩病患者瘘管进展的发生率是没有克罗恩病患者的两倍。识别有风险的患者可能有助于确定那些将从脓肿引流后的更保守手术方法、增强随访或检查中获益的患者。详见视频摘要，网址：http://links.lww.com/DCR/A798。
