Department of Gastroenterology, Amiens University Hospital, Picardie University, Amiens, France.
Department of Digestive Surgery, Amiens University Hospital, Picardie University, Amiens, France.
Clin Res Hepatol Gastroenterol. 2020 Nov;44(6):968-972. doi: 10.1016/j.clinre.2020.03.027. Epub 2020 Apr 23.
Most anal fistulas are crypto-glandular. Nevertheless, anal fistulas can reveal Crohn's disease (CD). The aim of our study was to evaluate the risk of developing CD in patients undergoing surgery for anal fistula.
All patients undergoing surgery for anal fistula in our center between January 1, 2008 and January 31, 2017 were identified through a prospective administrative database. Demographic, clinical, and laboratory data were retrospectively collected.
Ninety-three patients underwent anal exploration under general anesthesia. The median age at diagnosis of fistula was 43 years (IQR, 34-56) and 27% (n=29) were women. Twenty-seven percent (n=16) had had at least one previous fistula episode. After a median follow-up of 16.8 months (IQR, 7.2-42.0), seven (7.4%) patients were diagnosed with CD. The median time between the diagnosis of fistula and that of CD was 7.6 months (IQR, 2.7, 26.1). Chronic diarrhea (P=0.0003), weight loss (P=0.001), and chronic abdominal pain (P=0.002) were associated with the diagnosis of CD. Characteristics of the fistulas (number, simple/complex, abscess), smoking, extra-digestive manifestations of CD, or a family history of IBD were not associated with the diagnosis of CD.
A medical history of anal fistula surgery resulted in the diagnosis of CD in 7% of cases. Weight loss and the presence of digestive symptoms were associated with the diagnosis of CD. These elements could be used to select patients requiring endoscopic exploration after anal fistula.
大多数肛痿是隐匿性腺体的。然而，肛痿可能会揭示克罗恩病（CD）的存在。我们研究的目的是评估因肛痿而行手术的患者发展为 CD 的风险。
通过前瞻性行政数据库确定 2008 年 1 月 1 日至 2017 年 1 月 31 日期间在我们中心接受肛痿手术的所有患者。回顾性收集人口统计学、临床和实验室数据。
93 例患者在全身麻醉下接受了肛门探查。瘘管诊断的中位年龄为 43 岁（IQR，34-56），27%（n=29）为女性。27%（n=16）有至少一次先前的瘘管发作。中位随访 16.8 个月（IQR，7.2-42.0）后，有 7 例（7.4%）患者被诊断为 CD。肛痿和 CD 的诊断之间的中位时间为 7.6 个月（IQR，2.7，26.1）。慢性腹泻（P=0.0003）、体重减轻（P=0.001）和慢性腹痛（P=0.002）与 CD 的诊断相关。瘘管的特征（数量、单纯/复杂、脓肿）、吸烟、CD 的非消化系统表现或 IBD 的家族史与 CD 的诊断无关。
肛痿手术的病史导致 7%的病例诊断为 CD。体重减轻和存在消化症状与 CD 的诊断相关。这些因素可用于选择肛痿后需要内镜检查的患者。
