ObjectiveTo compare clinical efficacy of 4 kinds of surgical treatment for high transsphincter fistula. MethodsThe clinical data of 116 patients with high transsphincter fistula in Jiangsu Province Hospital of TCM from January 2012 to December 2014 were analyzed retrospectively.These patients were divided into 4 groups according to surgical treatments,including cut seton group (n=30),loose seton group (n=34),ligation of intersphincteric fistula tract group (LIFT,n=41),mucosa advancement flap group (MAF,n=11).The length of stay,incision healing time,postoperative pain score on the second day,Wexner score when healed,postoperative complications,curative status,and recurrence were observed. Results① The length of stay in the loose seton group was significantly longer than that in the LIFT group (P<0.01),cut seton group (P<0.05) or MAF group (P<0.05),but which had no differences among the other groups (P>0.05).② The incision healing time in the loose seton group was significantly longer than that in the LIFT group (P<0.01) or the MAF group (P<0.05),but which had no differences among the other groups (P>0.05).③ The postoperative pain score on the second day in the cut seton group was significantly higher than that in the other three groups (P<0.01),which in the MAF group was lower than that in the LIFT group (P<0.05),but which had no difference between the other groups (P>0.05).④The Wexner score when healed in the cut seton group was significantly higher than that in the other three groups (P<0.01),bwt which had no differences among the other groups (P>0.05).⑤ The rate of postoperative complica-tion in the LIFT group was significantly higher than that in the loose seton group (P<0.05),but which had no differences among the other groups (P>0.05).⑥ The curative rate and recurrence rate had no statistically differences among the 4 groups (P>0.05). ConclusionsCurative rate and recurrence rate in loose seton,LIFT,and MAF group are similar with cut seton group,meanwhile they could protect anal function better and relieve pain.The length of stay and the incision healing time are longer in the loose seton group.The postoperative complications in LIFT group is increased as compared with loose seton group.The postoperative pain of MAF group is slighter than that in LIFT group.Comprehensive evaluation,MAF has more advantages,but the technique is more complex.The decision should be made individually according to patients and surgeons.
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.
Objective To explore the effect of local injection of high concentration of glucose when removing setons of perianal fistulizing in Crohn’s disease (CD). Methods Thirty cases of CD combined with anal fistula admitted to the Affiliated Hospital of Nanjing University of Chinese Medicine from August 2015 to July 2017 were collected prospectively, 12 cases were divided into experimental group and 18 cases were divided into control group. Cases of the experimental group received demolition of drainage seton+IFX+local injection of high concentration of glucose treatment, cases of the control group received the drainage setons removing+IFX only. Before treatment, and at 6, 14, 22, and 30 weeks after IFX treatment, the laboratory indicators of the 2 groups were detected, and BMI, Crohn’s diseaseactivity index (CDAI), perianal disease activity index (PDAI), and clinical efficacy were evaluated. Results Therewas no significant difference on the group effect and interaction of group and time (P>0.05), but time (P<0.05). Both in the experimental group and the control group, compared with before treatment group, the counts of WBC and platelet, levels of C reaction protein (CRP) and erythrocyte sedimentation rate (ESR), CDAI, and PDAI at 6 months after IFX therapy decreased and maintained at the latter period, but the level of hemoglobin (Hb) and BMI increased at 6 weeks after IFX therapy and maintained at the latter period. On the clinical effect, there was no significant difference at the time points of 14, 22, and 30 weeks of IFX therapy (P>0.05). Conclusion The treatment of local injection of high concentration of glucose when removing setons has not shown any positive effect to CD combined with anal fistula, this conclusion needs to be further studied.