Cao D, Wang X, Qian K, Yang N, Xu K, Xu G, Zhu M, Zhang Y, Cui Z
Department of Gastrointestinal Surgery, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200127, China.
Department of General Surgery, Baoshan Branch, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200444, China.
Tech Coloproctol. 2024 Jul 31;28(1):89. doi: 10.1007/s10151-024-02949-9.
Fistula-tract laser closure (FiLaC™) has shown promising outcomes in perianal fistulizing Crohn's disease (pfCD). However, most studies assessed a mixed cohort encompassing pfCD and cryptoglandular fistulas during a short follow-up period. This study aimed to evaluate the long-term treatment outcomes of FiLaC™ in patients with complex pfCD.
Data from patients with complex pfCD who underwent FiLaC™ during deep remission of Crohn's disease between January 2019 and December 2020 were retrospectively analyzed. Patient demographics, surgery history, and medication strategy were registered before surgery. Follow-ups were scheduled at 1, 2, and 3 months after FiLaC™, and at 2-month intervals thereafter. The primary endpoint was clinic healing, while clinic remission/unhealed/recurrence were classified as unhealed. Additionally, adverse events and Wexner fecal incontinence score were documented.
Forty-nine patients (40 men and 9 women) with a median age of 26.0 (19.0-35.5) years were included with a median follow-up of 50.0 (39.5-54.0) months. Of these, 31 (63.3%) patients achieved fistula healing, 3 (6.1%) experienced improvement, 3 (6.1%) remained unhealed, and 12 (24.5%) experienced recurrence. Montreal A category was lower in the healed group (P < 0.001). No major complications, such as bleeding or fecal or urinary incontinence, were observed, and pain was transient. The Wexner incontinence score decreased significantly at the last available follow-up, indicating an intact postoperative continence function (P = 0.014). PCDAI scores were significantly higher in the unhealed group (P = 0.041).
FiLaC™ is an efficient and safe sphincter-saving procedure for patients with complex pfCD.
瘘管激光闭合术（FiLaC™）在肛周瘘管型克罗恩病（pfCD）中已显示出有前景的治疗效果。然而，大多数研究在短期随访期间评估的是包括pfCD和隐窝腺性瘘管的混合队列。本研究旨在评估FiLaC™在复杂性pfCD患者中的长期治疗效果。
对2019年1月至2020年12月期间在克罗恩病深度缓解期接受FiLaC™治疗的复杂性pfCD患者的数据进行回顾性分析。术前记录患者的人口统计学资料、手术史和用药策略。在FiLaC™术后1、2和3个月以及此后每隔2个月安排随访。主要终点是临床愈合，而临床缓解/未愈合/复发均归类为未愈合。此外，记录不良事件和韦克斯纳大便失禁评分。
纳入49例患者（40例男性和9例女性），中位年龄为26.0（19.0 - 35.5）岁，中位随访时间为50.0（39.5 - 54.0）个月。其中，31例（63.3%）患者实现瘘管愈合，3例（6.1%）病情改善，3例（6.1%）未愈合，12例（24.5%）复发。愈合组的蒙特利尔A分类较低（P < 0.001）。未观察到出血、大便或小便失禁等重大并发症，疼痛为一过性。在最后一次可用随访时，韦克斯纳失禁评分显著降低，表明术后控便功能完好（P = 0.014）。未愈合组的PCDAI评分显著更高（P = 0.041）。
对于复杂性pfCD患者，FiLaC™是一种有效且安全的保留括约肌手术。
