克罗恩病患者的肛门病理学

Anal pathology in patients with Crohn's disease.

作者信息

Platell C, Mackay J, Collopy B, Fink R, Ryan P, Woods R

机构信息

Department of Colon and Rectal Surgery, St. Vincent's Hospital, Victoria Parade, Melbourne, Australia.

出版信息

Aust N Z J Surg. 1996 Jan;66(1):5-9. doi: 10.1111/j.1445-2197.1996.tb00690.x.

DOI:10.1111/j.1445-2197.1996.tb00690.x

PMID:8629983

Abstract

BACKGROUND

A distinctive feature of patients suffering from Crohn's disease is a predisposition to develop a variety of anal complications. The aetiology of such conditions is unclear, and the reported incidence of anal involvement in Crohn's disease varies party due to the various criteria used for classification. This study aims to review the management of patients with symptomatic anal pathology associated with Crohn's disease at St Vincent's Hospital, Melbourne.

METHODS

A database of 306 patients with Crohn's disease referred to the department between January 1978 and October 1994 was reviewed to identify those patients with symptomatic anal disease. The anal pathology was recorded and classified. Demographic data and the clinical and surgery history of the patient were recorded.

RESULTS

Of the 306 patients with Crohn's disease, 129 (42.4%) were identified as having symptomatic anal pathology. Patients were likely to present with anal symptoms after they had been diagnosed as having intestinal Crohn's disease (46.1%). The commonest presentations were perianal abscess (29.5%), anal fissure (27.6%), and low anal fistula (26.7%). A minority of patients presented with high/complex anal fistulae (3.8%), or recto-vaginal fistulae (5.2%). Five per cent of patients had Crohn's disease localized to the anal area. The pattern of intestinal disease in the remaining patients was small bowel 21.1%. small bowel and colon 31.9%, and colon 43.0%. A total of 244 local anal and surgical procedures were performed on these patients; the commonest of these were drainage of an abscess (38.5%), examination under anaesthetic (29.1%), and laying open of a low anal fistula (22.5%). Following surgical treatment, the recurrence rate for perianal abscesses was 13%, and for low anal fistulae 6%.

CONCLUSIONS

The majority of patients with Crohn's disease who develop anal pathology have an excellent prognosis. A minority of patients develop complex anal complex anal fistulae and these remain a therapeutic challenge.

摘要

背景

克罗恩病患者的一个显著特征是易发生多种肛门并发症。此类病症的病因尚不清楚，而且由于用于分类的标准各异，报道的克罗恩病肛门受累发病率也有所不同。本研究旨在回顾墨尔本圣文森特医院对患有与克罗恩病相关的有症状肛门病变患者的治疗情况。

方法

回顾了1978年1月至1994年10月间转诊至该科室的306例克罗恩病患者的数据库，以确定那些有症状肛门疾病的患者。记录并分类肛门病变情况。记录患者的人口统计学数据以及临床和手术史。

结果

在306例克罗恩病患者中，129例（42.4%）被确定有症状肛门病变。患者在被诊断为肠道克罗恩病后更易出现肛门症状（46.1%）。最常见的表现是肛周脓肿（29.5%）、肛裂（27.6%）和低位肛瘘（26.7%）。少数患者表现为高位/复杂性肛瘘（3.8%）或直肠阴道瘘（5.2%）。5%的患者克罗恩病局限于肛门区域。其余患者的肠道疾病模式为小肠病变占21.1%，小肠和结肠病变占31.9%，结肠病变占43.0%。对这些患者共进行了244次局部肛门和外科手术；其中最常见的是脓肿引流（38.5%）、麻醉下检查（29.1%）和低位肛瘘切开（22.5%）。手术治疗后，肛周脓肿的复发率为13%，低位肛瘘的复发率为6%。