回肠-肛门袋相关瘘管：一篇综述
Ileoanal Pouch-Related Fistulas: A Narrative Review
DOI 原文链接
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影响因子:4.3
分区:医学3区 / 胃肠肝病学3区
发表日期:2025 Jun 13
作者:
Sergio Bronze, Maia Kayal, Maria Manuela Estevinho, Sue Hahn, Sergey Khaitov, Jean-Frederic Colombel, Serre-Yu Wong
DOI:
10.1093/ibd/izae221
摘要
回肠-肛门袋相关瘘管（IAPRF）是结肠-肛门吻合术后可能出现的并发症，显著影响袋的预后和患者的生活质量。本研究旨在进行系统性综述，以更好地分类IAPRF的流行病学、危险因素、病因、管理和预后，提出其系统分类的算法。分析了10项涉及664例IAPRF患者的研究，发病率范围为4%至45%。报道的瘘管类型包括：阴道瘘（236例，占35.5%）、会阴瘘（139例，占21%）、肠皮肤瘘（54例，占8%）、肛-袋瘘（53例，占8%）、骶前瘘（18例，占2%）和吻合瘘（15例，占2%）。手术后盆腔脓毒症发生率为21%至37.2%。另有20项关于瘘管分类的研究，根据发病时间和病因，将其划分为五类：吻合相关、手术技术因素、克罗恩病样袋炎、隐窝腺瘘以及恶性肿瘤。约70%的患者接受了袋切除术。与吻合并发症、手术技术问题和隐窝腺瘘相关的瘘管需要外科手术治疗，而与炎症相关的瘘管则优先采用生物制剂或小分子药物治疗。© 本文作者2024年由牛津大学出版社代表克罗恩病与结肠炎基金会发表。商业再用请联系reprints@oup.com获取转载权限。其他权限可通过我们网站上的Permissions链接，通过RightsLink服务申请，详情请联系journals.permissions@oup.com。
Abstract
Ileoanal pouch-related fistula (IAPRF) is a possible complication after ileal pouch-anal anastomosis that significantly impacts pouch prognosis and the patient's quality of life. This study aimed to perform a comprehensive narrative review to better classify the epidemiology, risk factors, etiology, management, and outcomes of IAPRF, and to propose an algorithm for its systematic classification. Ten studies comprising 664 patients with IAPRF were identified, with a prevalence ranging from 4% to 45%. The reported fistula types were as follows: pouch-vaginal (n = 236, 35.5%), perineal (n = 139, 21%), enterocutaneous (n = 54, 8%), pouch-anal (n = 53, 8%), presacral (n = 18, 2%), and anastomotic (n = 15, 2%). Postsurgical pelvic sepsis occurred in 21%-37.2% of patients. Twenty additional studies regarding fistula classification divided them according to onset time and etiology, defining 5 categories: anastomotic-related, technical aspects of the surgery, Crohn's disease-like pouch inflammation, cryptoglandular, and malignancy. Pouch excision was reported in up to 70% of patients. Fistulas associated with anastomotic complications, technical surgical issues, and cryptoglandular fistulas warrant surgical management. On the other hand, fistulas associated with inflammation are preferentially managed with biologics or small molecules.© The Author(s) 2024. Published by Oxford University Press on behalf of Crohn’s & Colitis Foundation. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.