Makowiec F, Jehle E C, Starlinger M
Department of Surgery, Eberhard-Karls-University, Tübingen, Germany.
Gut. 1995 Nov;37(5):696-701. doi: 10.1136/gut.37.5.696.
The clinical course of perianal fistulas and associated abscesses was evaluated prospectively in 90 patients with Crohn's disease. Fistula type, rectal disease, faecal diversion, and immunosuppression were examined as prognostic indicators for fistula healing and recurrence. Median follow up was 22 months. The outcome was evaluated with life table analysis. Prognostic factors were analysed by multiple regression. Inactivation was achieved in all patients. The risks of recurrent fistula activity were 48% at one year and 59% at two years. Fistulas were healed in 51% after two years but reopened in 44% within 18 months of healing. Faecal diversion and absence of rectal disease decreased recurrence rates (p = 0.019/0.04) and increased healing rates (p = 0.005/0.017). The outcome in patients with trans-sphincteric fistulas was better than that in those with ischiorectal fistulas but worse than in patients with subcutaneous fistulas (p = 0.015 for healing; p = 0.007 for recurrent fistula activity). After initial treatment about 20% of the patients were symptomatic and about 10% had painful events per six month period. Incontinence was rare and did not increase during the study period. Perianal fistulas and associated abscesses can be controlled safely by simple drainage of pus collections. Frequent reinfection and re-opening after healing of fistulas are characteristic. Fistula type, rectal disease, and stool contamination influence the clinical course. Only a few patients, however, have continuous symptoms from perianal fistulas.
对90例克罗恩病患者的肛周瘘管及相关脓肿的临床病程进行了前瞻性评估。对瘘管类型、直肠疾病、粪便转流和免疫抑制作为瘘管愈合和复发的预后指标进行了研究。中位随访时间为22个月。采用寿命表分析评估结果。通过多元回归分析预后因素。所有患者均实现了灭活。复发性瘘管活动的风险在1年时为48%，2年时为59%。两年后51%的瘘管愈合，但在愈合后的18个月内44%再次开放。粪便转流和无直肠疾病降低了复发率（p = 0.019/0.04）并提高了愈合率（p = 0.005/0.017）。经括约肌瘘管患者的预后优于坐骨直肠瘘管患者，但比皮下瘘管患者差（愈合方面p = 0.015；复发性瘘管活动方面p = 0.007）。初始治疗后约20%的患者有症状，每6个月约10%的患者有疼痛事件。失禁很少见，且在研究期间没有增加。肛周瘘管及相关脓肿可通过简单的脓肿引流安全控制。瘘管愈合后频繁的再感染和再次开放是其特点。瘘管类型、直肠疾病和粪便污染影响临床病程。然而，只有少数患者有肛周瘘管的持续症状。
