保留括约肌挂线引流术联合英夫利昔单抗治疗肛周瘘管型克罗恩病的短期临床疗效_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

王浩 , 徐民民 , 竺平 , 贡钰霞 , 李悠然 , 陈红锦 , 陈邑岐 ,  谷云飞

江苏省中医院肛肠科（南京 210029）;

Corresponding author：

谷云飞, Email: Guyunfei127@126.com

Keywords：

瘘管型克罗恩病; 肛周; 英夫利昔单抗; 保留括约肌挂线引流术; 疗效

DOI：

10.7507/1007-9424.201703124

Video：

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目的总结保留括约肌挂线引流术联合英夫利昔单抗（infliximab，IFX）治疗肛周瘘管型克罗恩病（Crohn disease，CD）的短期临床疗效。方法回顾性分析江苏省中医院肛肠科于 2010 年 3 月至 2011 年 6 月期间收治的接受保留括约肌挂线引流术联合 IFX 治疗的 20 例肛周瘘管型 CD 患者的临床资料，治疗方案为降阶梯治疗。在第 0、2 及 6 周分别给予 5 mg/kg IFX 静脉注射诱导治疗，随后给予每 8 周 1 次、共 3 次的 IFX 维持治疗（5 mg/kg），共计 6 次。于治疗前和第 0、6 及 30 周治疗后评估克罗恩病活动指数（CDAI）、肛周克罗恩病活动指数（PCDAI）、治疗效果及瘘管闭合情况，并开展实验室检测。结果 ① CDAI 和 PCDAI：与治疗前比较，第 0、6 及 30 周的 CDAI 和 PCDAI 均较低（P<0.05）。② 瘘管闭合：第 0 周时，18 例瘘管部分闭合，2 例无效；第6 周时，16 例瘘管完全闭合，4 例部分闭合；第 30 周时，16 例瘘管完全闭合，1 例部分闭合，3 例复发。③ 实验室检查：与治疗前比较，第 0、6 及 30 周的 C-反应蛋白（CRP）水平、红细胞沉降率（ESR）、血小板计数、中性粒细胞百分比及白细胞计数均较低（P<0.05），第 6 周和第 30 周的血红蛋白水平较高（P<0.05）。④ 不良反应：治疗过程中 3 例次发生不良反应。结论保留括约肌挂线引流术联合 IFX 降阶梯治疗对肛周瘘管型 CD 有效。

Citation： 王浩, 徐民民, 竺平, 贡钰霞, 李悠然, 陈红锦, 陈邑岐, 谷云飞. 保留括约肌挂线引流术联合英夫利昔单抗治疗肛周瘘管型克罗恩病的短期临床疗效. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2017, 24(11): 1380-1383. doi: 10.7507/1007-9424.201703124 Copy

1.	Gomollón F, Dignass A, Annese V, et al. 3^rd European evidence-based consensus on the diagnosis and management of crohn’s disease 2016: part 1: diagnosis and medical management. J Crohns Colitis, 2017, 11(1): 3-25.
2.	中华医学会消化病学会炎症性肠病协作组. 炎症性肠病诊断与治疗的共识意见(2012年广州). 中华内科杂志, 2012, 51(10): 818-831.
3.	Best WR, Becktel JM, Singleton JW, et al. Development of a Crohn’s disease activity index. National Cooperative Crohn’s Disease Study. Gastroenterology, 1976, 70(3): 439-444.
4.	Irvine EJ. Usual therapy improves perianal Crohn’s disease as measured by a new disease activity index. McMaster IBD Study Group. J Clin Gastroenterol, 1995, 20(1): 27-32.
5.	Gecse KB, Bemelman W, Kamm MA, et al. A global consensus on the classification, diagnosis and multidisciplinary treatment of perianal fistulising Crohn’s disease. Gut, 2014, 63(9): 1381-1392.
6.	Lichtenstein GR, Hanauer SB, Sandborn WJ, et al. Management of Crohn’s disease in adults. Am J Gastroenterol, 2009, 104(2): 465-483.
7.	Panaccione R, Ferraz JG, Beck P. Advances in medical therapy of inflammatory bowel disease. Curr Opin Pharmacol, 2005, 5(6): 566-572.
8.	D’Haens GR, Panaccione R, Higgins PD, et al. The London Position Statement of the World Congress of Gastroenterology on Biological Therapy for IBD with the European Crohn’s and Colitis Organization: when to start, when to stop, which drug to choose, and how to predict response? Am J Gastroenterol, 2011, 106(2): 199-212.
9.	Keane J, Gershon S, Wise RP, et al. Tuberculosis associated with infliximab, a tumor necrosis factor alpha-neutralizing agent. N Engl J Med, 2001, 345(15): 1098-1104.
10.	Baert F, Noman M, Vermeire S, et al. Influence of immunogenicity on the long-term efficacy of infliximab in Crohn’s disease. N Engl J Med, 2003, 348(7): 601-608.
11.	Mahadevan U, Cucchiara S, Hyams JS, et al. The London Position Statement of the World Congress of Gastroenterology on Biological Therapy for IBD with the European Crohn’s and Colitis Organisation: pregnancy and pediatrics. Am J Gastroenterol, 2011, 106(2): 214-223.
12.	de Groof EJ, Sahami S, Lucas C, et al. Treatment of perianal fistula in Crohn’s disease: a systematic review and meta-analysis comparing seton drainage and anti-tumour necrosis factor treatment. Colorectal Dis, 2016, 18(7): 667-675.
13.	Siddiqui MR, Ashrafian H, Tozer P, et al. A diagnostic accuracy meta-analysis of endoanal ultrasound and MRI for perianal fistula assessment. Dis Colon Rectum, 2012, 55(5): 576-585.
14.	徐民民, 王浩, 谷云飞. 英夫利昔单抗联合直肠推移黏膜瓣治疗克罗恩病肛瘘的疗效初探. 中国普外基础与临床杂志, 2015, 22(9): 1121-1123.
15.	Buchanan GN, Owen HA, Torkington J, et al. Long-term outcome following loose-seton technique for external sphincter preservation in complex anal fistula. Br J Surg, 2004, 91(4): 476-480.

1. Gomollón F, Dignass A, Annese V, et al. 3^rd European evidence-based consensus on the diagnosis and management of crohn’s disease 2016: part 1: diagnosis and medical management. J Crohns Colitis, 2017, 11(1): 3-25.
2. 中华医学会消化病学会炎症性肠病协作组. 炎症性肠病诊断与治疗的共识意见(2012年广州). 中华内科杂志, 2012, 51(10): 818-831.
3. Best WR, Becktel JM, Singleton JW, et al. Development of a Crohn’s disease activity index. National Cooperative Crohn’s Disease Study. Gastroenterology, 1976, 70(3): 439-444.
4. Irvine EJ. Usual therapy improves perianal Crohn’s disease as measured by a new disease activity index. McMaster IBD Study Group. J Clin Gastroenterol, 1995, 20(1): 27-32.
5. Gecse KB, Bemelman W, Kamm MA, et al. A global consensus on the classification, diagnosis and multidisciplinary treatment of perianal fistulising Crohn’s disease. Gut, 2014, 63(9): 1381-1392.
6. Lichtenstein GR, Hanauer SB, Sandborn WJ, et al. Management of Crohn’s disease in adults. Am J Gastroenterol, 2009, 104(2): 465-483.
7. Panaccione R, Ferraz JG, Beck P. Advances in medical therapy of inflammatory bowel disease. Curr Opin Pharmacol, 2005, 5(6): 566-572.
8. D’Haens GR, Panaccione R, Higgins PD, et al. The London Position Statement of the World Congress of Gastroenterology on Biological Therapy for IBD with the European Crohn’s and Colitis Organization: when to start, when to stop, which drug to choose, and how to predict response? Am J Gastroenterol, 2011, 106(2): 199-212.
9. Keane J, Gershon S, Wise RP, et al. Tuberculosis associated with infliximab, a tumor necrosis factor alpha-neutralizing agent. N Engl J Med, 2001, 345(15): 1098-1104.
10. Baert F, Noman M, Vermeire S, et al. Influence of immunogenicity on the long-term efficacy of infliximab in Crohn’s disease. N Engl J Med, 2003, 348(7): 601-608.
11. Mahadevan U, Cucchiara S, Hyams JS, et al. The London Position Statement of the World Congress of Gastroenterology on Biological Therapy for IBD with the European Crohn’s and Colitis Organisation: pregnancy and pediatrics. Am J Gastroenterol, 2011, 106(2): 214-223.
12. de Groof EJ, Sahami S, Lucas C, et al. Treatment of perianal fistula in Crohn’s disease: a systematic review and meta-analysis comparing seton drainage and anti-tumour necrosis factor treatment. Colorectal Dis, 2016, 18(7): 667-675.
13. Siddiqui MR, Ashrafian H, Tozer P, et al. A diagnostic accuracy meta-analysis of endoanal ultrasound and MRI for perianal fistula assessment. Dis Colon Rectum, 2012, 55(5): 576-585.
14. 徐民民, 王浩, 谷云飞. 英夫利昔单抗联合直肠推移黏膜瓣治疗克罗恩病肛瘘的疗效初探. 中国普外基础与临床杂志, 2015, 22(9): 1121-1123.
15. Buchanan GN, Owen HA, Torkington J, et al. Long-term outcome following loose-seton technique for external sphincter preservation in complex anal fistula. Br J Surg, 2004, 91(4): 476-480.

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CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

保留括约肌挂线引流术联合英夫利昔单抗治疗肛周瘘管型克罗恩病的短期临床疗效

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