Arjafallah Goulet Oumniya, Brochard Charlène, Siproudhis Laurent, Etienney Isabelle
Proctology Department, Diaconesses Croix Saint-Simon Hospital Group, 125 Rue d'Avron, 75020, Paris, France.
Gastroenterology and Proctology Department, Pontchaillou University Hospital, 2 Rue Henri Le Guilloux, 35 000, Rennes, France.
Int J Colorectal Dis. 2025 Sep 10;40(1):192. doi: 10.1007/s00384-025-04991-x.
This study aimed to describe Crohn's disease perianal fistulizing lesions in patients undergoing surgery over 60 years to compare clinical presentation, management and outcomes with those observed in younger patients.
Between January 2012 and December 2022, all patients over 60 years old who underwent a first surgical intervention for anal fistula at two medical centers were included. For each patient included, two younger patients who underwent the same surgical procedure during the same period in the same centers were matched for comparison.
Among 536 patients who underwent surgery, 6% (n = 30) aged over 60 years at first surgery were included. Compared with their younger counterparts, older patients had: i) a diagnosis of Crohn's disease and fistula more often in the same year: 63% vs 26%, p = 0.001; ii) combined therapy and anti-TNF alpha optimization less often (p = 0.0002 and p = 0.0001); iii) fewer surgical interventions: 3 vs 4.5, p = 0.008; iv) sparing surgery less frequently: 30% vs 58%, p = 0.01; v) fistulotomy more often: 27% vs 5%, p = 0.003. The rates of anal fistula closure were comparable between the two groups: 60% vs 62%, p = 0.93.
Synchronous diagnosis of anal fistula and Crohn's disease within the first year of care is not uncommon after 60 years of age, suggesting that Crohn's disease should not be overlooked in older individuals developing an anal fistula. Despite receiving less aggressive medical management due to age-related factors, elderly patients achieved similar fistula closure rates, through a more pragmatic surgical approach, including more fistulotomies in selected patients.
本研究旨在描述60岁以上接受手术治疗的克罗恩病肛周瘘管性病变患者的情况，以比较其临床表现、治疗方法及预后与年轻患者的差异。
纳入2012年1月至2022年12月期间在两家医疗中心首次接受肛瘘手术的所有60岁以上患者。对于每例纳入患者，匹配同期在同一中心接受相同手术的两名年轻患者进行比较。
在536例接受手术的患者中，首次手术时年龄超过60岁的患者有6%（n = 30）。与年轻患者相比，老年患者有：i）同年诊断克罗恩病和肛瘘的情况更常见：63% 对26%，p = 0.001；ii）联合治疗和抗TNF-α优化治疗较少（p = 0.0002和p = 0.0001）；iii）手术干预较少：3次对4.5次，p = 0.008；iv）保留括约肌手术较少：30% 对58%，p = 0.01；v）瘘管切开术较多：27% 对5%，p = 0.003。两组肛瘘闭合率相当：60% 对62%，p = 0.93。
60岁以后，在首次就诊的第一年内同时诊断肛瘘和克罗恩病并不少见，这表明在发生肛瘘的老年个体中不应忽视克罗恩病。尽管由于年龄相关因素接受的积极药物治疗较少，但老年患者通过更务实的手术方法，包括对选定患者进行更多的瘘管切开术，实现了相似的肛瘘闭合率。
