中国普外基础与临床杂志

中国普外基础与临床杂志

单中心139例克罗恩病肛瘘的临床特征分析

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目的 总结克罗恩病肛瘘的临床特征。 方法 回顾性分析 2010 年 1 月至 2017 年 1 月期间南京中医药大学附属医院肛肠科收治住院的 139 例克罗恩病肛瘘患者的临床资料。 结果 139 例患者中男女比约为 3.3∶1.0,诊断年龄(28±8)岁,47.5% 患者的肛瘘出现先于 CD 诊断。有肛周手术史和药物治疗史的患者分别占 64.7% 和 74.1%。病变部位中回结肠型占 49.6%;疾病行为中炎症型(B1 型)和狭窄型(B2 型)分别占 51.8% 和 41.0%;复杂肛瘘占 90.6%;31.7% 的患者合并肛门直肠狭窄。46.0% 的患者存在腹泻的症状,单纯肛周病变占 29.5%。54.0% 的患者的 BMI 异常,64.7% 的患者的 CD 活动指数(CDAI)处于活动期,94.2% 患者的肛周病变活动指数(PDAI)处于活动期。53.2% 的患者的红细胞沉降率(ESR)高于正常值。logistic 回归结果显示,诊断年龄和 CDAI 评分是 CD 肛瘘伴发肛门直肠狭窄的独立危险因素(P<0.05)。 结论 CD 肛瘘患者的发病年龄轻,男性多于女性,以回结肠型、炎症型和狭窄型多见,肛瘘症状常先于肠道症状出现,腹泻为最常见的肠道表现。患者常有肛周脓肿和肛瘘手术史,容易合并肛门直肠狭窄,肠道炎症多处于活动期,部分患者的实验室炎症指标异常。此外,诊断年龄越大、CDAI 评分越高,CD 肛瘘合并肛门直肠狭窄的风险越高。

Objective To explore the clinical characteristics of Crohn’s disease (CD) with perianal fistula by analyzing the clinical data of them. Methods A total of 139 cases of CD with perianal fistula who got treatment from January 2010 to January 2017 in The Affiliated Hospital of Nanjing University of Traditional Chinese Medicine were analyzed retrospectively. Results The proportion of males and females in 139 patients was about 3.3∶1.0, the age was (28±8) years, and 47.5% of patients had perianal fistula before CD diagnosis. The percents of patients with perianal surgery history and medication history were 64.7% and 74.1%, respectively. The ratio of L3 type (diseased position) was 49.6%. The ratios of inflammatory type (B1 type) and stenotic type (B2 type) of the disease were 51.8% and 41.0%, respectively. The complex perianal fistula accounted for 90.6%, and 31.7% of patients combined analrectal stricture. Symptoms of diarrhea were found in 46.0% of patients and perianal lesions alone in 29.5% of patients; 54.0% of patients combined with abnormal BMI; 64.7% of patients were in the active stage of Crohn’s disease activity index (CDAI) and 94.2 % of patients were in the active period of perianal disease activity index (PDAI). The patients with erythrocyte sedimentation rate (ESR) higher than normal were 53.2%. The results of logistic showed that, age and degree of CDAI were influencing factors for CD with stenosis of perianal fistula. Conclusions Characteristics of patients with CD combined with perianal fistula include: young, men predominant, high prevalence of ileocolic position involvement, as well as inflammation and stenosis disease behavior. Fistula symptoms often preced the intestinal symptoms and diarrhea is the most common intestinal performance. History of perianal abscess and fistula operation are common. The anorectal stricture are complicated usually. Intestinal inflammation is active. Some patients show abnormal laboratory indicators of inflammation. This suggests that patients with perianal fistula with these clinical features should be alert to the possibility of CD, so as toavoid the consequences of blind surgery. The higher CDAI score and the older the diagnosis age, the higher the risk ofrectal stenosis.

关键词: 克罗恩病; 肛瘘; 临床特征

Key words: Crohn’s disease; perianal fistula; clinical characteristic

引用本文: 徐民民, 竺平, 王浩, 陈红锦, 谷云飞, 曾莉. 单中心139例克罗恩病肛瘘的临床特征分析. 中国普外基础与临床杂志, 2018, 25(10): 1176-1182. doi: 10.7507/1007-9424.201806034 复制

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