Factors influencing the outcomes of two-stage radical surgery for perianal fistulizing Crohn′s disease
10.3760/cma.j.cn101480-20200710-00079
- VernacularTitle:克罗恩病肛瘘二期根治性手术结局的影响因素分析
- Author:
Heng ZHANG
1
;
Yizhou SUN
;
Dan SU
;
Wei WANG
;
Jia KE
;
Donglin REN
Author Information
1. 中山大学附属第六医院肛肠外科，广州 510655
- Publication Type:Journal Article
- Keywords:
Crohn′s disease;
Anal fistula;
Platelet;
Screening;
Seton drainage;
Radical surgery;
Multidisciplinary therapy
- From:
Chinese Journal of Inflammatory Bowel Diseases
2021;05(2):156-161
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To explore the factors which influence the outcomes of two-stage radical surgery for the patients with perianal fistulizing Crohn′s disease (pfCD) .Methods:Clinical data of 31 pfCD patients who underwent two-stage radical surgery in the Sixth Affiliated Hospital of Sun Yat-sen University from March 2016 to June 2018 were analyzed retrospectively. All the patients got good drainage results comfirmed by MRI after the treatment of one-stage seton drainage and the following medical treatment. According to the outcome of two-stage radical surgery, the patients were divided into the healing group ( n = 23) and the failed group ( n = 8) . The clinical characteristics between the two groups were analyzed statistically. Wilcoxon rank sum test was used to analyze the difference in C-reactive protein (CRP) , erythrocyte sedimentation rate (ESR) , platelet (PLT) , body mass index (BMI) , hemoglobin (HB) and albumin (ALB) between before the one-stage seton drainage and before the two-stage radical surgery in each group. Results:The healing rate of pfCD after two-stage radical surgery was 74.2% (23/31) . The ratio of proctitis before the one-stage seton drainage (8.70% vs.50.00%, P = 0.026) , the ratio of multiple internal openings or multiple independent fistulas before the one-stage seton drainage (21.74% vs. 75.00%, P = 0.012) and the PLT before the two-stage radical surgery [240.0 (202.0, 277.0) × 10 9/L vs. 319.5 (247.3, 385.5) × 10 9/L, P = 0.04] in the healing group were significantly lower than those in the failed group. The variations of PLT [240.0 (202.0, 277.0) × 10 9/L vs. 300.9 (230.0, 413.0) × 10 9/L, P = 0.004], HB [136.0 (114.0, 144.0) g/L vs. 127.0 (107.0, 137.0) g/L, P = 0.004], ALB[43.10 (39.62, 47.41) g/L vs. 40.45 (36.58, 42.58) g/L, P = 0.011] and BMI [19.93 (17.99, 21.22) kg/m 2 vs. 18.22 (16.61, 19.38) kg/m 2, P<0.001] in the healing group before two-stage radical surgery showed better trends than those before one-stage seton drainage, while there was no significant variation trend of ESR and CRP between the two points in time (both P>0.05) . There were no sigificant differences in all indexes in the failed group between before one-stage seton drainage and before the two-stage radical surgery (all P>0.05) . Conclusions:Beside the initial proctitis and multiple internal openings or multiple independent fistulas, PLT level before the two-stage radical surgery for pfCD is also an influencing factor of surgical outcome. The situations of BMI, HB, ALB, and PLT before the two-stage radical surgery are better than those before the one-stage seton drainage may be used as the screening indications of the radical surgery.
