Department of Colon and Rectal Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
Department of Colon and Rectal Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
Asian J Surg. 2021 Nov;44(11):1383-1388. doi: 10.1016/j.asjsur.2021.03.013. Epub 2021 May 6.
This study was designed to assess the demographic characteristics of patients with Crohn's perianal fistula (CPF) who were treated at a tertiary referral institution. Surgical outcomes were compared in groups of patients who underwent seton placement, fistulotomy, and stem cell therapy.
Patients who underwent surgery for CPF between 2015 and 2017 at Asan Medical Center, Seoul, Korea, were retrospectively evaluated. Patients were divided into groups who underwent seton placement, fistulotomy, and stem cell therapy. Their clinical variables and closure rates were compared.
This study included 156 patients who underwent a total of 209 operations. More than half of the operations consisted of seton placement (67%), followed by stem cell therapy (18%) and fistulotomy (15%) patients. Of the 209 fistulas, 153 (73%) were complex, with an overall closure rate of 38% during a median follow-up of 29 months. Closure rates following fistulotomy, stem cell therapy, and seton placement were 90%, 70%, and 18%. Seton placement was more significantly frequently used than the other procedures in patients with complex fistula and those with abscesses. Of the 79 fistulas that achieved complete closure, 11 (14%) recurred. The recurrence rates did not differ among the various techniques.
Surgical treatment of CPF is dependent on lesion type. Seton placement was the primary draining procedure for complex fistulas and abscesses, resulting in low closure rates. Fistulotomy was the definite procedure for low type and simple fistula. Stem cell therapy showed high closure rates as definitive treatment, even for complex fistulas.
本研究旨在评估在一家三级转诊机构接受治疗的克罗恩病肛周瘘（CPF）患者的人口统计学特征。比较了接受挂线置管、瘘管切开和干细胞治疗的患者的手术结果。
回顾性评估了 2015 年至 2017 年在韩国首尔峨山医学中心接受 CPF 手术的患者。将患者分为接受挂线置管、瘘管切开和干细胞治疗的组。比较了他们的临床变量和闭合率。
本研究共纳入 156 例患者，共进行了 209 次手术。超过一半的手术为挂线置管（67%），其次是干细胞治疗（18%）和瘘管切开术（15%）患者。在 209 个瘘管中，153 个（73%）为复杂型，中位随访 29 个月时总闭合率为 38%。瘘管切开术、干细胞治疗和挂线置管的闭合率分别为 90%、70%和 18%。在复杂瘘和脓肿患者中，挂线置管的应用频率明显高于其他手术。在 79 个完全闭合的瘘中，有 11 个（14%）复发。不同技术之间的复发率没有差异。
CPF 的手术治疗取决于病变类型。挂线置管是复杂瘘和脓肿的主要引流术，其闭合率较低。瘘管切开术是低位和简单瘘的确定性手术。干细胞治疗作为确定性治疗，即使对于复杂瘘，也显示出较高的闭合率。
