OBJECTIVE: To investigate the clinical characteristics, treatment, and prognosis of children with perianal fistulizing Crohn\'s disease (pfCD).
METHODS: A retrospective analysis was conducted on the children, aged 6-17 years, who were diagnosed with Crohn\'s disease (CD) from April 2015 to April 2023. According to the presence or absence of perianal fistulizing lesions, they were divided into two groups: pfCD (n=60) and non-pfCD (n=82). The two groups were compared in terms of clinical characteristics, treatment, and prognosis.
RESULTS: The incidence of pfCD was 42.3% (60/142). The proportion of males in the pfCD group was higher than that in the non-pfCD group. Compared with the non-pfCD group, the pfCD group had a significantly higher proportion of children with involvement of the colon and small intestine or those with upper gastrointestinal lesions (P<0.05). Compared with the non-pfCD group, the pfCD group had a significantly higher rate of use of infliximab during both induction and maintenance treatment (P<0.05). In the pfCD group, the children with complex anal fistula accounted for 62% (37/60), among whom the children receiving non-cutting suspended line drainage accounted for 62% (23/37), which was significantly higher than the proportion among the children with simple anal fistula patients (4%, 1/23) (P<0.05). There were no significant differences between the two groups in mucosal healing rate and clinical remission rate at week 54 of treatment (P>0.05). The pfCD group achieved a fistula healing rate of 57% (34/60) at week 54, and the children with simple anal fistula had a significantly higher rate than those with complex anal fistula (P<0.05).
CONCLUSIONS: There is a high incidence rate of pfCD in children with CD, and among the children with pfCD, there is a high proportion of children with the use of biological agents. There is a high proportion of children receiving non-cutting suspended line drainage among the children with complex anal fistula. The occurrence of pfCD should be closely monitored during the follow-up in children with CD.
目的: 分析儿童肛周瘘管型克罗恩病（perianal fistulizing Crohn\'s disease, pfCD）患儿的临床特征、治疗及预后。方法: 回顾性选择2015年4月2023年4月间诊断为克罗恩病（Crohn\'s disease, CD）的6~17岁患儿142例为研究对象，根据是否存在肛周瘘管型病变，分为pfCD组（60例）和非pfCD组（82例），比较两组患儿的临床特征、治疗及预后。结果: pfCD发生率为42.3%（60/142）。pfCD组男性比例，病变范围累及结肠、小肠结肠比例，以及合并上消化道病变的比例高于非pfCD组（P<0.05）。pfCD组英夫利西单抗诱导缓解及维持缓解治疗比例高于非pfCD组（P<0.05）。pfCD组中，复杂性肛瘘患儿占62%（37/60），肛瘘非切割性挂线引流术治疗在复杂性肛瘘患儿中比例为62%（23/37），显著高于简单性肛瘘患儿（4%，1/23）（P<0.05）。两组患儿治疗54周黏膜愈合率和临床缓解率差异均无统计学意义（P>0.05）。pfCD组治疗54周瘘管愈合率为57%（34/60），其中简单性肛瘘患儿瘘管愈合率高于复杂性肛瘘患儿（P<0.05）。结论: 儿童CD患者中pfCD发生率高，pfCD患儿生物制剂使用比例高，复杂性肛瘘非切割性挂线引流术比例高，CD患儿随访中需要密切关注pfCD的发生。.

OBJECTIVE: The medico-surgical strategy for the treatment of perianal fistulizing Crohn\'s disease (CD) following surgical drainage remains challenging and debated. Our aims were to describe the failure rate of therapeutic interventions after drainage of the fistula tract and determine the factors associated with failure to optimize medico-surgical strategies.
METHODS: All consecutive patients with perianal fistulizing CD who underwent surgical drainage with at least a 12-week follow-up were included. Failure was defined as the occurrence of at least one of the following items: abscess recurrence, purulent discharge from the tract, visible external opening and further drainage procedure(s).
RESULTS: One hundred and sixty-nine patients were included. The median follow-up was 4.0 years. The cumulative failure rates were 20%, 30% and 36% at 1, 3 and 5 years, respectively. The cumulative failure rates in patients who had sphincter-sparing surgeries or seton removal were significantly higher than in those who had a fistulotomy. Anterior fistula [hazard ratio (HR) = 2.52 (1.13-5.61), P = 0.024], supralevator extension [HR = 20.78 (3.38-127.80), P = 0.001] and the absence or discontinuation of immunosuppressants after anal drainage [HR = 3.74 (1.11-12.5), P = 0.032] were significantly associated with failure in the multivariate analysis model.
CONCLUSIONS: Combined strategies for perianal fistulizing CD lead to a failure rate of 36% at 5 years. Where advisable, fistulotomy may be preferred because it has a lower rate of recurrence. The benefits of immunosuppressants require a dedicated prospective randomized trial.