背景:瘘管激光闭合术(FiLaC™)在肛周造瘘性克罗恩病(pfCD)中显示出有希望的结果。然而,大多数研究在较短的随访期内评估了包含pfCD和隐腺管瘘的混合队列.本研究旨在评估FiLaC™在复杂pfCD患者中的长期治疗结果。
方法:回顾性分析2019年1月至2020年12月在克罗恩病深度缓解期间接受FiLaC™治疗的复杂pfCD患者的数据。患者人口统计学,手术史,术前登记用药策略。随访安排在FiLaC™后1、2和3个月,此后每隔2个月。主要终点是临床愈合,而临床缓解/未愈/复发被归类为未愈。此外,记录不良事件和Wexner大便失禁评分.
结果:纳入49名患者(40名男性和9名女性),中位年龄为26.0(19.0-35.5)岁,中位随访时间为50.0(39.5-54.0)个月。其中,31例(63.3%)患者实现瘘管愈合,3(6.1%)经历了改善,3(6.1%)仍未愈合,12例(24.5%)复发。治疗组的蒙特利尔A组较低(P<0.001)。无重大并发症,如出血或大便或尿失禁,被观察到,疼痛是短暂的。在最后一次可用的随访中,Wexner失禁评分显着下降,表明术后失禁功能完整(P=0.014)。未愈合组PCDAI评分明显高于未愈合组(P=0.041)。
结论:FiLaC™对于复杂pfCD患者是一种有效且安全的保括约肌手术。
BACKGROUND: Fistula-tract laser closure (FiLaC™) has shown promising outcomes in perianal fistulizing Crohn\'s disease (pfCD). However, most studies assessed a mixed cohort encompassing pfCD and cryptoglandular fistulas during a short follow-up period. This study aimed to evaluate the long-term treatment outcomes of FiLaC™ in patients with complex pfCD.
METHODS: Data from patients with complex pfCD who underwent FiLaC™ during deep remission of Crohn\'s disease between January 2019 and December 2020 were retrospectively analyzed. Patient demographics, surgery history, and medication strategy were registered before surgery. Follow-ups were scheduled at 1, 2, and 3 months after FiLaC™, and at 2-month intervals thereafter. The primary endpoint was clinic healing, while clinic remission/unhealed/recurrence were classified as unhealed. Additionally, adverse events and Wexner fecal incontinence score were documented.
RESULTS: Forty-nine patients (40 men and 9 women) with a median age of 26.0 (19.0-35.5) years were included with a median follow-up of 50.0 (39.5-54.0) months. Of these, 31 (63.3%) patients achieved fistula healing, 3 (6.1%) experienced improvement, 3 (6.1%) remained unhealed, and 12 (24.5%) experienced recurrence. Montreal A category was lower in the healed group (P < 0.001). No major complications, such as bleeding or fecal or urinary incontinence, were observed, and pain was transient. The Wexner incontinence score decreased significantly at the last available follow-up, indicating an intact postoperative continence function (P = 0.014). PCDAI scores were significantly higher in the unhealed group (P = 0.041).
CONCLUSIONS: FiLaC™ is an efficient and safe sphincter-saving procedure for patients with complex pfCD.