Sugita A, Koganei K, Harada H, Yamazaki Y, Fukushima T, Shimada H
Second Department of Surgery, Yokohama City University Hospital (Urafune), Japan.
J Gastroenterol. 1995 Nov;30 Suppl 8:143-6.
The aim of this study was to analyze the features of Crohn's anal fistulas and to evaluate the efficacy of seton treatment. In 119 patients with Crohn's disease, the incidence of anal fistula was 56% (67/119), with no significant difference in the incidence among patients with ileitis, colitis, and ileocolitis. "Intractable" anal fistulas were found in 17% of patients with ileitis, compared to 64% of those with colitis (P = 0.051) and 68% of those with ileocolitis (P = 0.014). Seton treatment, i.e., non-cutting, long-term seton drainage, was performed for 21 patients (5 with intersphincteric, and 16 with transsphincteric fistulas). In the 16-month follow up, 9 patients required redrainage for recurrent fistulous abscess, mainly because of progressive colorectal disease. Finally, a good result was obtained in 17 of the 21 patients (81%) and no recurrent fistulous abscess developed in the 8 patients in whom all setons were removed. Anal continence was preserved in all the patients. These results indicate that anal fistulas with Crohn's ileitis were cured more easily than those with colitis or ileocolitis, and that seton treatment was effective for intersphincteric fistula with multiple fistula openings and for transphincteric fistulas in patients exhibiting remission of intestinal Crohn's disease.
本研究的目的是分析克罗恩病肛瘘的特征，并评估挂线疗法的疗效。119例克罗恩病患者中，肛瘘发生率为56%（67/119），回肠炎、结肠炎和回结肠患者的肛瘘发生率无显著差异。回肠炎患者中17%有“难治性”肛瘘，相比之下，结肠炎患者中这一比例为64%（P = 0.051），回结肠患者中为68%（P = 0.014）。对21例患者（5例括约肌间肛瘘和16例经括约肌肛瘘）实施了挂线疗法，即非切割、长期挂线引流。在16个月的随访中，9例患者因肛瘘复发脓肿需要再次引流，主要原因是结直肠疾病进展。最终，21例患者中有17例（81%）取得了良好效果，8例拆除所有挂线的患者未出现肛瘘复发脓肿。所有患者的肛门节制功能均得以保留。这些结果表明，克罗恩病回肠炎所致肛瘘比结肠炎或回结肠所致肛瘘更容易治愈，且挂线疗法对有多个瘘口的括约肌间肛瘘以及肠道克罗恩病处于缓解期患者的经括约肌肛瘘有效。
