克罗恩病合并肛门周围疾病的诊治

Diagnosis and treatment of perianal Crohn′s disease

在克罗恩病的并发症中,肛门周围疾病较为常见,其诊断除用儿童常规体格检查和麻醉下肛瘘探查术外,盆腔磁共振显像无创伤且准确性较好。评估肛瘘活动性采用肛周疾病活动指数,肛瘘分类临床上以单纯性和复杂性分类应用最多。治疗上单纯肛瘘以内科治疗为主,常用甲硝唑/环丙沙星、硫唑嘌呤/6-巯基嘌呤、infliximab,或上述两种药物联合应用;复杂肛瘘应内外科联合治疗,肛周脓肿应及时切开引流。

Perianal Crohn＇s disease is one of the most common complications of Crohn＇s disease. The diagnosis includes local physical examination, examination under anesthesia and magnetic resonance imaging（MRI）. MRI is recommended as first choice because it is woundless and accuracy. Perianal disease activity index（PDAI） is used to assess activity. The classification in practice is simple and complicated anal fistula. Simple fistula is treated with medicine, such as metronidazole, ciprofloxacin, azathioprine/6-mercaptopurine or infliximab, sometimes combining both. Complicated fistula is treated with medicine and surgery. Perianal abscess needs incision and drainage.