Stein B L, Gordon P H
Department of Colon and Rectal Surgery, Lahey Clinic Medical Center, Burlington, MA 01805, USA.
Curr Opin Gen Surg. 1993:141-6.
Perianal complications of Crohn's disease are fairly common in the adult and pediatric populations. Transrectal ultrasonography is effective for the diagnosis and follow-up of patients with anorectal abscesses and fistulas in Crohn's disease. Metronidazole and 6-mercaptopurine therapy have been used effectively to treat perianal complications of Crohn's disease in the pediatric population. Asymptomatic perianal fistulas in a patient with Crohn's disease do not require treatment. If a fistula is symptomatic and involves only a small portion of the sphincter mechanism, conventional fistulotomy may be performed with good results. Complex fistulas that involve larger areas of the sphincter are best treated by optimizing medical management and seton placement. The management of rectovaginal fistulas in the presence of Crohn's disease is controversial. Conventional fistulotomy and transvaginal mucosal advancement flap with diverting ileostomy have been advocated as primary treatment modalities. Rectovaginal fistulas secondary to ulcerative colitis may be treated by ileoanal pouch anastomosis and primary repair.
克罗恩病的肛周并发症在成人和儿童群体中相当常见。经直肠超声检查对于克罗恩病患者的肛管直肠脓肿和肛瘘的诊断及随访是有效的。甲硝唑和6-巯基嘌呤疗法已被有效地用于治疗儿童克罗恩病的肛周并发症。克罗恩病患者无症状的肛周肛瘘无需治疗。如果肛瘘有症状且仅累及括约肌机制的一小部分，可进行传统的肛瘘切开术，效果良好。累及括约肌较大区域的复杂肛瘘最好通过优化药物治疗和放置挂线来处理。克罗恩病患者直肠阴道瘘的处理存在争议。传统的肛瘘切开术和带转流性回肠造口术的经阴道黏膜推进皮瓣术已被提倡作为主要治疗方式。溃疡性结肠炎继发的直肠阴道瘘可通过回肠肛管吻合术和一期修复来治疗。
