Bayer I, Gordon P H
Department of Surgery, Sir Mortimer B. Davis-Jewish General Hospital, Montreal, Quebec, Canada.
Dis Colon Rectum. 1994 Aug;37(8):760-5. doi: 10.1007/BF02050138.
The operative management of patients with fistula-in-ano in the presence of Crohn's disease has been controversial. Our aim was to review the results of operative treatment in this clinical setting.
Twenty-eight such patients treated between 1976 and 1990 were reviewed. The duration of local symptoms, location of the Crohn's disease, medications, and previous operations were noted. An effort was made to classify the fistula-in-ano according to Parks' classification, but many fistulas were complicated and did not neatly fit into one of the described categories (intersphincteric 9, transsphincteric 10, complex 9). Patients underwent fistulotomy (three with a seton).
Complete healing was achieved in 71.4 percent of cases with an average healing time of 3.5 months (range, 3 weeks-26 months). With an average follow-up of 71 months (range, 12 months-14 years), postoperative function was good in 20 (71.5 percent) patients. Of the remaining eight patients, five ultimately underwent total proctocolectomy because of the severity of their colorectal disease, one patient developed alteration of continence, and two patients developed stenosis. There were two recurrences, (one at nine months and one at six years).
Operative treatment should be offered to selected patients with fistula-in-ano in the presence of Crohn's disease.
对于患有克罗恩病并发肛瘘的患者，手术治疗一直存在争议。我们的目的是回顾在这种临床情况下手术治疗的结果。
对1976年至1990年间治疗的28例此类患者进行回顾。记录局部症状持续时间、克罗恩病的位置、用药情况及既往手术史。尝试根据帕克斯分类法对肛瘘进行分类，但许多瘘管情况复杂，并不完全符合所描述的类别（括约肌间型9例、经括约肌型10例、复杂型9例）。患者接受了瘘管切开术（3例使用挂线疗法）。
71.4%的病例实现了完全愈合，平均愈合时间为3.5个月（范围3周 - 26个月）。平均随访71个月（范围12个月 - 14年），20例（71.5%）患者术后功能良好。其余8例患者中，5例因结直肠疾病严重最终接受了全直肠结肠切除术，1例患者出现了大便失禁，2例患者出现了狭窄。有2例复发（1例在9个月时，1例在6年时）。
对于患有克罗恩病并发肛瘘的部分患者，应提供手术治疗。
