Halme L, Sainio A P
Fourth Department of Surgery, Helsinki University Central Hospital, Finland.
Dis Colon Rectum. 1995 Jan;38(1):55-9. doi: 10.1007/BF02053858.
Relation of clinical factors to frequency, type, and, in particular, outcome of anal fistulas in Crohn's disease was studied.
One hundred twelve patients seen in this hospital between January 1972 and June 1993 who suffered from Crohn's disease were included in the study. Those 35 (31 percent) with anal fistulas were re-examined or interviewed and asked about their perianal symptoms and anal control.
Rectal involvement of Crohn's disease was associated with an increased incidence of anal fistula (49 vs. 17 percent; P < 0.01), especially high ones (82 vs. 17 percent; P < 0.01). Ten of 18 patients with low fistulas underwent fistulotomy; all 10 fistulas healed, but slowly (mean healing time, 7.5 months), and 4 of them recurred. Of eight low fistulas managed by drainage alone, four healed. Finally, 11 of 18 patients with low fistulas had their fistulas heated. Fourteen of 17 patients with high fistulas were primarily treated by drainage and 3 by local surgery. Finally, only three patients had healed fistulas--two after simple drainage and one after local surgery, and seven patients had to undergo proctectomy. Only two patients with low fistulas required proctectomy. Eight patients (33 percent) of those 24 with fistulas in whom anal continence could be assessed, 5 with local surgery and 3 with drainage alone, reported minor defects in anal control.
Fistulotomy is a justifiable option with satisfactory results for low symptomatic anal fistulas associated with Crohn's disease, although healing may be delayed and some fistulas will recur. Outcome of high fistulas is less satisfactory, and proctectomy is ultimately required in a number of patients; therefore, for high fistulas a conservative approach is primarily recommended.
研究临床因素与克罗恩病肛瘘的发生率、类型，尤其是结局之间的关系。
本研究纳入了1972年1月至1993年6月间在本院就诊的112例克罗恩病患者。其中35例（31%）患有肛瘘，对其进行了复查或访谈，询问了他们的肛周症状及肛门控制情况。
克罗恩病累及直肠与肛瘘发生率增加相关（49%对17%；P<0.01），尤其是高位肛瘘（82%对17%；P<0.01）。18例低位肛瘘患者中有10例行瘘管切开术；所有10例瘘管均愈合，但愈合缓慢（平均愈合时间7.5个月），其中4例复发。8例仅行引流的低位肛瘘中，4例愈合。最后，18例低位肛瘘患者中有11例行瘘管热凝术。17例高位肛瘘患者中，14例首先接受引流治疗，3例接受局部手术治疗。最后，只有3例患者的瘘管愈合——2例经单纯引流愈合，1例经局部手术愈合，7例患者不得不接受直肠切除术。只有2例低位肛瘘患者需要行直肠切除术。在24例可评估肛门节制功能的肛瘘患者中，8例（33%）报告有轻微的肛门控制缺陷，其中5例接受局部手术，3例仅行引流。
对于与克罗恩病相关的有症状低位肛瘘，瘘管切开术是一种合理的选择，效果满意，尽管愈合可能延迟且一些瘘管会复发。高位肛瘘的结局不太理想，许多患者最终需要行直肠切除术；因此，对于高位肛瘘，主要推荐采用保守治疗方法。
