Crohn病致肛瘘的治疗

目的探讨Crohn病致肛瘘的治疗方法。方法分析手术治疗的37例Crohn病致肛瘘患者的临床资料,随访术后复发及肛门自制功能障碍的发生情况。结果37例患者术后复发13例(35.1%),术后肛门失禁5例(13.5%)。11例存在直肠炎者7例复发(63.6%),显著高于非直肠炎者(23.1%)(P=0.028);存在直肠炎者肛门失禁发生率36.4%,亦显著高于非直肠炎者(3.8%)(P=0.021)。低位肛瘘患者术后肛门失禁发生率显著低于高位肛瘘患者(4.2%vs30.8%,P=0.042)。高位肛瘘病例中,挂线疗法患者术后肛门失禁发生率显著高于非切断括约肌术式患者(66.7%vs0.0%,P=0.021)。结论Crohn病致肛瘘患者治疗较为困难,应首先行规范的药物治疗争取非手术治愈,药物治疗无效者行手术治疗。术前须控制直肠炎。低位肛瘘宜行瘘管切开术,高位肛瘘应采用非切断括约肌的手术。

Treatment of anal fistulas in Crohn's disease

Objective To analyse the subject of treatment of anal fistulas in Crohn's disease. Methods Retrospective analysis of clinical data of 37 patients with anal fistula in Crohn's disease who were surgically treated was conducted.Patients were followed up of relapse and anal incontinence. Results In 37 patients with anal fistula in Crohn's disease,13(35.1%) relapse and 5(13.5%) incontinence occurred after surgical treatment.The patients with rectitis involving Crohn's disease had significantly higher relapse rate(63.6% vs 23.1%,P=0.028) and incontinence rate(36.4% vs 3.8%,P=0.021) after operation than those without rectitis involving.Postoperative incontinence rate in low fistula patients was significantly lower than that in high fistula(4.2% vs 30.8%,P=0.042).To high fistula patients with Crohn's disease,postoperative incontinence was significantly more frequently observed in cutting seton group than that in sphincter preserve operation group(66.7% vs 0.0%,P=0.021). Conclusion It is difficult to treat anal fistulas in Crohn's disease.Those patients with anal fistula in Crohn's disease should take standard medical treatment first and take surgical treatment as a choice for relapse and no-response to medical treatment.The rectitis involving must be controlled before operation.Fistulotomy is acceptable in low fistula,and high fistula patients should be operated with sphincter preserving procedures.