Leardi S, Simi M, Verde B, Pietroletti R, Risetti A, Aloisio F, Speranza V
VI Clinica Chirurgica, Università La Sapienza, Roma.
Ital J Surg Sci. 1988;18(3):247-52.
Problems related to the appearance of non perianal fistulas and abscesses are examined in a series of 204 patients operated on for Crohn's disease. Incidence of these complications was 34.3% (70 cases); one or more fistulas were present in 54 patients, associated with abscesses in 13, while abscesses alone were present in 3. The highest incidence was observed in the male sex, in patients over 50 years, and in the presence of stenosing Crohn's lesions (P less than 0.001). On the contrary, the primary site of Crohn's disease does not seem to affect significantly their appearance. The clinical suspect of fistulas or abscesses should be supported with radiographic, endoscopic, echographic and scintiscan findings, even though about 7.2% of fistulas are diagnosed only intraoperatively. Surgical treatment is the most suitable therapeutic management; however enteroenteric and mesenteric fistulas are only relative indications for surgery. TPN is suitable for postoperative enteric fistulas (5 cases). Postoperative morbidity is not different in patients with or without such complications at surgery. Long-term prognosis of non perianal fistulas and abscesses is related only to recurrences of Crohn's disease and their anatomopathologic evolution.
对204例因克罗恩病接受手术的患者出现的非肛周瘘管和脓肿相关问题进行了研究。这些并发症的发生率为34.3%（70例）；54例患者存在一个或多个瘘管，其中13例伴有脓肿，3例仅有脓肿。男性、50岁以上患者以及存在狭窄性克罗恩病变的患者中发生率最高（P<0.001）。相反，克罗恩病的原发部位似乎对其出现没有显著影响。即使约7.2%的瘘管仅在术中被诊断出，瘘管或脓肿的临床怀疑也应得到影像学、内镜、超声和闪烁扫描结果的支持。手术治疗是最合适的治疗方法；然而，肠-肠瘘和肠系膜瘘仅是手术的相对指征。全胃肠外营养适用于术后肠瘘（5例）。手术时有或无此类并发症的患者术后发病率无差异。非肛周瘘管和脓肿的长期预后仅与克罗恩病的复发及其解剖病理学演变有关。
