Bernard D, Morgan S, Tassé D
Can J Surg. 1986 Sep;29(5):318-21.
To establish specific indications for the surgical treatment of perianal Crohn's disease, the authors report their experience with 102 patients (45%) with these lesions in a series of 225 patients with small- and large-bowel Crohn's disease. Ulcerations or fissures were present in 50%, abscesses developed in 32% and fistulas in 53%. More than one type of lesion was present in 59%. One of six patients had no symptoms, in one of five the lesion was etiologically independent of Crohn's disease and one of four patients did not require surgical intervention. Severe pain indicated an abscess that required drainage, and 57% of patients who underwent drainage alone or with an added seton later required fistulotomy to become symptom-free. Primary fistulotomy for abscess achieved complete healing in 71% of cases and fistulotomy also healed in 60% of chronic fistulas for a combined fistulotomy healing rate of 63% when anal Crohn's disease was present and 68% in all patients with Crohn's disease. Anal dilatations with bougies were effective in short stenoses which were present in 7% of cases. Twelve percent of patients required excision of the rectum to be relieved of their symptoms.
为确定肛周克罗恩病手术治疗的具体指征，作者报告了他们在225例小肠和大肠克罗恩病患者中对102例（45%）有这些病变患者的治疗经验。50%的患者存在溃疡或肛裂，32%出现脓肿，53%出现肛瘘。59%的患者存在不止一种病变类型。六分之一的患者无症状，五分之一的患者病变在病因上与克罗恩病无关，四分之一的患者不需要手术干预。严重疼痛提示存在需要引流的脓肿，57%仅接受引流或同时放置挂线的患者后来需要行肛瘘切开术才能缓解症状。因脓肿行一期肛瘘切开术的病例中71%实现完全愈合，慢性肛瘘行肛瘘切开术的愈合率为60%，存在肛门克罗恩病时肛瘘切开术的综合愈合率为63%，所有克罗恩病患者的愈合率为68%。用探条进行肛门扩张对7%病例中存在的短缩狭窄有效。12%的患者需要切除直肠才能缓解症状。
