保留括約肌掛線引流術聯合英夫利昔單抗治療肛周瘺管型克羅恩病的短期臨床療效_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

王浩 , 徐民民 , 竺平 , 貢鈺霞 , 李悠然 , 陳紅錦 , 陳邑岐 ,  谷云飛

江蘇省中醫院肛腸科（南京 210029）;

Corresponding?author：

谷云飛, Email: Guyunfei127@126.com

Keywords：

瘺管型克羅恩病; 肛周; 英夫利昔單抗; 保留括約肌掛線引流術; 療效

DOI：

10.7507/1007-9424.201703124

Video：

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目的總結保留括約肌掛線引流術聯合英夫利昔單抗（infliximab，IFX）治療肛周瘺管型克羅恩病（Crohn disease，CD）的短期臨床療效。方法回顧性分析江蘇省中醫院肛腸科于 2010 年 3 月至 2011 年 6 月期間收治的接受保留括約肌掛線引流術聯合 IFX 治療的 20 例肛周瘺管型 CD 患者的臨床資料，治療方案為降階梯治療。在第 0、2 及 6 周分別給予 5 mg/kg IFX 靜脈注射誘導治療，隨后給予每 8 周 1 次、共 3 次的 IFX 維持治療（5 mg/kg），共計 6 次。于治療前和第 0、6 及 30 周治療后評估克羅恩病活動指數（CDAI）、肛周克羅恩病活動指數（PCDAI）、治療效果及瘺管閉合情況，并開展實驗室檢測。結果 ① CDAI 和 PCDAI：與治療前比較，第 0、6 及 30 周的 CDAI 和 PCDAI 均較低（P<0.05）。② 瘺管閉合：第 0 周時，18 例瘺管部分閉合，2 例無效；第6 周時，16 例瘺管完全閉合，4 例部分閉合；第 30 周時，16 例瘺管完全閉合，1 例部分閉合，3 例復發。③ 實驗室檢查：與治療前比較，第 0、6 及 30 周的 C-反應蛋白（CRP）水平、紅細胞沉降率（ESR）、血小板計數、中性粒細胞百分比及白細胞計數均較低（P<0.05），第 6 周和第 30 周的血紅蛋白水平較高（P<0.05）。④ 不良反應：治療過程中 3 例次發生不良反應。結論保留括約肌掛線引流術聯合 IFX 降階梯治療對肛周瘺管型 CD 有效。

Citation： 王浩, 徐民民, 竺平, 貢鈺霞, 李悠然, 陳紅錦, 陳邑岐, 谷云飛. 保留括約肌掛線引流術聯合英夫利昔單抗治療肛周瘺管型克羅恩病的短期臨床療效. 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.	中華醫學會消化病學會炎癥性腸病協作組. 炎癥性腸病診斷與治療的共識意見(2012年廣州). 中華內科雜志, 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, 谷云飛. 英夫利昔單抗聯合直腸推移黏膜瓣治療克羅恩病肛瘺的療效初探. 中國普外基礎與臨床雜志, 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. 中華醫學會消化病學會炎癥性腸病協作組. 炎癥性腸病診斷與治療的共識意見(2012年廣州). 中華內科雜志, 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, 谷云飛. 英夫利昔單抗聯合直腸推移黏膜瓣治療克羅恩病肛瘺的療效初探. 中國普外基礎與臨床雜志, 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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保留括約肌掛線引流術聯合英夫利昔單抗治療肛周瘺管型克羅恩病的短期臨床療效

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