Becker M A J, Pronk A J M, Gecse K, Hompes R, Bemelman W A, Buskens C J
Tytgat Institute for Liver and Intestinal Research, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.
Department of Surgery, Amsterdam UMC, Location AMC, Amsterdam, The Netherlands.
Colorectal Dis. 2025 Feb;27(2):e17289. doi: 10.1111/codi.17289.
This study aimed to analyse long-term outcomes in patients undergoing temporary faecal diversion for therapy-refractory Crohn's perianal fistulas.
In this retrospective study, Crohn's patients who underwent defunctioning for perianal disease between 2012 and 2022 were included. The primary endpoints were successful ostomy reversal and proctectomy/proctocolectomy rates. Secondary endpoints were clinical fistula closure, development of proximal colonic disease recurrence, and the influence of medication, patient and disease characteristics on ostomy reversal.
In total, 53 patients were included, 35 colostomies and 18 ileostomies. Previous L2 disease was more frequently seen in the ileostomy group (colostomy 29%, ileostomy 83%; P = 0.004). Clinical closure of the fistula was seen in 26%. 21% (11/53 patients) underwent an attempt at ostomy reversal during a median overall follow-up of 90.1 months (interquartile range 17.5-82.5) of which nine ostomies (colostomy 23%, ileostomy 6%; P = 0.244) were closed successfully. In 35%, a proctectomy/proctocolectomy was required to control ongoing perianal sepsis. Factors associated with ostomy reversal were fistula closure (P < 0.001) and L1/L3 disease (P = 0.043). In patients with ostomy reversal attempt (n = 11), successful reversal was associated with colostomy (P = 0.055) and use of anti-tumour necrosis factor (anti-TNF) (P = 0.055) despite being previously classified as anti-TNF refractory.
Ostomy reversal rates are low, so defunctioning ostomies should be carefully considered because in most patients the ostomy will be permanent. In one-third of the patients, a proctectomy/proctocolectomy is required to treat ongoing perianal sepsis. If a patient is eligible for ostomy reversal, reversal should preferably be done under anti-TNF to optimize chances of success.
本研究旨在分析因治疗难治性克罗恩病肛周瘘而接受临时性粪便转流术患者的长期预后。
在这项回顾性研究中，纳入了2012年至2022年间因肛周疾病接受去功能化手术的克罗恩病患者。主要终点为造口回纳成功和直肠切除术/直肠结肠切除术的发生率。次要终点为临床肛瘘闭合、近端结肠疾病复发情况，以及药物、患者和疾病特征对造口回纳的影响。
共纳入53例患者，其中35例行结肠造口术，18例行回肠造口术。回肠造口术组既往L2期疾病更为常见（结肠造口术组29%，回肠造口术组83%；P = 0.004）。26%的患者临床肛瘘闭合。在中位总随访时间90.1个月（四分位间距17.5 - 82.5）内，21%（11/53例患者）尝试进行造口回纳，其中9例造口（结肠造口术23%，回肠造口术6%；P = 0.244）成功回纳。35%的患者需要进行直肠切除术/直肠结肠切除术以控制持续性肛周感染。与造口回纳相关的因素为肛瘘闭合（P < 0.001）和L1/L3期疾病（P = 0.043）。在尝试造口回纳的患者（n = 11）中，尽管之前被归类为抗TNF难治性，但成功回纳与结肠造口术（P = 0.055）和使用抗肿瘤坏死因子（抗TNF）药物（P = 0.055）相关。
造口回纳率较低，因此应谨慎考虑去功能化造口术，因为大多数患者的造口将是永久性的。三分之一的患者需要进行直肠切除术/直肠结肠切除术来治疗持续性肛周感染。如果患者符合造口回纳条件，回纳最好在抗TNF治疗下进行，以优化成功几率。
