Joo J S, Weiss E G, Nogueras J J, Wexner S D
Department of Colorectal Surgery, Cleveland Clinic Florida, Fort Lauderdale 33309, USA.
Am Surg. 1998 Feb;64(2):147-50.
The aim of this study was to evaluate the outcome of patients undergoing endorectal advancement flap repair for perianal Crohn's disease relative to the primary site of intestinal Crohn's disease. From January 1991 to December 1995, 31 consecutive endorectal advancement flap repairs were performed in 26 patients. The results relative to surgical outcomes, length of hospitalization, and recurrence were analyzed. The mean patient age was 40.2 years (range, 16-70). Type of fistulas included: rectovaginal: 20 (64.5%), fistula in ano: 8 (25.8%), rectourethral: 1 (3.2%) and others: 2 (6.5%). The mean length of follow-up was 17.3 (range 3-60) months. The mean length of hospitalization was 3.7 (range 2-5) days. A temporary diverting stoma was created in 6 patients with a 66.7% (4/6) surgical success rate. Twenty-one of the 26 patients had previous procedures consisting of 12 (38.7%) bowel resections, 6 (19.4%) seton placements, 4 (12.9%) drainages, and 6 (19.4%) diverting ileostomies. Eleven patients had multiple procedures. Ultimately, fistulas were eradicated in 22 (71%) cases, including 15 (75%) of the 20 with rectovaginal fistulas and 7 (63.6%) of the 11 with other fistulas. There was no mortality; morbidity included a flap retraction in 1 patient, who required antibiotics for 5 days and bleeding in 1 patient, who required reoperation. Success was noted in 2 of 8 (25%) patients with small bowel Crohn's disease as compared to 20 of 23 (87%) patients without small bowel Crohn's disease (P < 0.05). Endorectal advancement flap is an effective surgical modality for the treatment of fistulas due to perianal Crohn's disease but is less apt to succeed in patients with concomitant small bowel Crohn's disease.
本研究的目的是评估接受直肠内推进皮瓣修复术治疗肛周克罗恩病的患者相对于肠道克罗恩病原发部位的治疗结果。1991年1月至1995年12月，连续对26例患者进行了31次直肠内推进皮瓣修复术。分析了手术结果、住院时间和复发情况。患者平均年龄为40.2岁（范围16 - 70岁）。瘘管类型包括：直肠阴道瘘：20例（64.5%），肛门瘘：8例（25.8%），直肠尿道瘘：1例（3.2%），其他：2例（6.5%）。平均随访时间为17.3个月（范围3 - 60个月）。平均住院时间为3.7天（范围2 - 5天）。6例患者行临时性转流造口术，手术成功率为66.7%（4/6）。26例患者中有21例曾接受过手术，包括12例（38.7%）肠切除术、6例（19.4%）挂线术、4例（12.9%）引流术和6例（19.4%）转流性回肠造口术。11例患者接受过多次手术。最终，22例（71%）患者的瘘管得以根除，其中20例直肠阴道瘘患者中有15例（75%），11例其他瘘管患者中有7例（63.6%）。无死亡病例；并发症包括1例皮瓣回缩，患者接受了5天抗生素治疗，1例出血，患者接受了再次手术。8例小肠克罗恩病患者中有2例（25%）治疗成功，而23例无小肠克罗恩病患者中有20例（87%）治疗成功（P < 0.05）。直肠内推进皮瓣是治疗肛周克罗恩病所致瘘管的一种有效手术方式，但对于合并小肠克罗恩病的患者不太容易成功。
