Garg Pankaj, Goyal Ankita, Yagnik Vipul D, Dawka Sushil, Menon Geetha R
Department of Colorectal Surgery, Indus International Hospital, Mohali 140507, Punjab, India.
Department of Pathology, Gian Sagar Medical College and Hospital, Patiala 140506, Punjab, India.
World J Gastrointest Surg. 2021 Apr 27;13(4):355-365. doi: 10.4240/wjgs.v13.i4.355.
The association of tuberculosis (TB) with anal fistulas can make its treatment quite difficult. The main challenge is timely detection of TB in anal fistulas and its proper management. There is little data available on diagnosis and management of TB in anal fistulas.
To detect TB in fistula-in-ano patients were analyzed in different methods utilized.
A retrospective analysis of different methods, polymerase chain-reaction (PCR), GeneXpert and histopathology (HPE), utilized to detect tuberculosis in fistula-in-ano patients, treated between 2014-2020, was performed. The sampling was done for tissue (fistula tract lining) and pus (when available). The detection rate of various tests to detect TB and prevalence rate of TB in simple complex fistulae were studied.
In 1336 samples (776 patients) tested, TB was detected in 133 samples (122 patients). TB was detected in 52/703 (7.4%) samples tested by PCR-tissue, in 77/331 (23.2%) samples tested by PCR-pus, 3/197 (1.5%) samples tested with HPE-tissue and 1/105 (0.9%) samples tested by GeneXpert. To detect TB, PCR-tissue was significantly better than HPE-tissue (52/703 3/197 respectively) ( = 0.0012, significant, Fisher's exact test) and PCR-pus was significantly better than PCR-tissue (77/331 52/703 respectively) ( < 0.00001, significant, Fisher's exact test). TB fistulas were more complex than non-tuberculous fistulas [78/113 (69%) 278/727 (44.3%) respectively] ( < 0.00001, significant, Fisher's exact test) but the overall healing rate was similar in tuberculous and non-tuberculous fistula groups [90/102 (88.2%) 518/556 (93.2%) respectively] ( = 0.10, not significant, Fisher's exact test).
This is the largest study of anorectal TB to be published. The detection of TB by polymerase chain-reaction was significantly higher than by histopathology and GeneXpert. Amongst polymerase chain-reaction, pus had a higher detection rate than tissue. TB fistulas were more complex than non-tuberculous fistulas but aggressive diagnosis and meticulous treatment led to comparable overall success rates in both groups.
结核病（TB）与肛瘘相关会使其治疗颇具难度。主要挑战在于及时检测出肛瘘中的结核病并进行妥善管理。关于肛瘘中结核病的诊断和管理，可用数据较少。
分析在肛管直肠瘘患者中采用不同方法检测结核病的情况。
对2014年至2020年期间接受治疗的肛管直肠瘘患者采用不同方法（聚合酶链反应（PCR）、GeneXpert和组织病理学（HPE））检测结核病进行回顾性分析。对组织（瘘管内衬）和脓液（如有）进行采样。研究了各种检测结核病的试验的检出率以及单纯性和复杂性肛瘘中结核病的患病率。
在检测的1336份样本（776例患者）中，133份样本（122例患者）检测出结核病。通过PCR - 组织检测的703份样本中有52份（7.4%）检测出结核病，通过PCR - 脓液检测的331份样本中有77份（23.2%）检测出结核病，通过HPE - 组织检测的197份样本中有3份（1.5%）检测出结核病，通过GeneXpert检测的105份样本中有1份（0.9%）检测出结核病。为检测结核病，PCR - 组织显著优于HPE - 组织（分别为52/703和3/197）（P = 0.0012，显著，Fisher精确检验），PCR - 脓液显著优于PCR - 组织（分别为77/331和52/703）（P < 0.00001，显著，Fisher精确检验）。结核性肛瘘比非结核性肛瘘更复杂[分别为78/113（69%）和278/727（44.3%）]（P < 0.00001，显著，Fisher精确检验），但结核性和非结核性肛瘘组的总体愈合率相似[分别为90/102（88.2%）和518/556（93.2%）]（P = 0.10，不显著，Fisher精确检验）。
这是已发表的关于肛管直肠结核的最大规模研究。聚合酶链反应检测结核病的检出率显著高于组织病理学和GeneXpert。在聚合酶链反应中，脓液的检出率高于组织。结核性肛瘘比非结核性肛瘘更复杂，但积极的诊断和细致的治疗使两组的总体成功率相当。
