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_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

 徐民民 , 王浩 ,  谷云飞

江苏省中医院肛肠科（江苏南京 210029）;

Corresponding author：

谷云飞, Email: guyunfei127@126.com

Keywords：

克罗恩病肛瘘; 英夫利昔单抗; 直肠推移黏膜瓣

DOI：

10.7507/1007-9424.20150290

Video：

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目的对英夫利昔单抗联合直肠推移黏膜瓣治疗克罗恩病肛瘘的临床疗效和安全性进行初步探讨。方法回顾性分析江苏省中医院2011年6月至2014年5月期间收治的行英夫利昔单抗联合直肠推移黏膜瓣治疗的10例克罗恩病肛瘘患者的临床资料，总结患者的肛瘘愈合情况、肛门功能以及治疗过程中的不良反应。结果 10例患者中有9例患者的瘘管近期闭合，1例患者术后发生黏膜瓣感染。10例患者的瘘管闭合时间为术后1～4周（平均2周）。术后所有患者的肛门自制功能较术前均无明显改变，且所有患者在治疗过程中均未发生不良事件。术后10例患者获访，随访时间6个月～3年，中位数为12个月。随访期间，有1例患者于术后10个月发生肛瘘复发。结论英夫利昔单抗联合直肠推移黏膜瓣治疗克罗恩病肛瘘较为安全，且有一定疗效。

Citation： 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. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2015, 22(9): 1121-1123. doi: 10.7507/1007-9424.20150290 Copy

1.	Schwartz DA, Loftus EV Jr, Tremaine WJ, et al. The natural history of fistulizing Crohn's disease in Olmsted County, Minnesota. Gastroenterology, 2002, 122(4):875-880.
2.	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.
3.	El-Gazzaz G, Hull T, Church JM. Biological immunomodulators improve the healing rate in surgically treated perianal Crohn's fistulas. Colorectal Dis, 2012, 14(10):1217-1223.
4.	Present DH, Rutgeerts P, Targan S, et al. Infliximab for the treat-ment of fistulas in patients with Crohn's disease. N Engl J Med, 1999, 340(18):1398-1405.
5.	Stringer EE, Nicholson TJ, Armstrong D. Efficacy of topical metronidazole (10 percent) in the treatment of anorectal Crohn's disease. Dis Colon Rectum, 2005, 48(5):970-974.
6.	杨柏霖, 林秋, 陈红锦, 等. 英夫利昔单抗联合手术治疗克罗恩病肛瘘的临床疗效. 中华胃肠外科杂志, 2013, 16(4):323-327.
7.	杨柏霖, 竺平, 孙桂东. 克罗恩病肛瘘的诊断与治疗. 世界华人消化杂志, 2009, 17(20):2058-2063.
8.	Marchesa P, Hull TL, Fazio VW. Advancement sleeve flaps for treatment of severe perianal Crohn's disease. Br J Surg, 1998, 85(12):1695-1698.
9.	Soltani A, Kaiser AM. Endorectal advancement flap for cryptoglan-dular or Crohn,s fistula-in-ano. Dis Colon Rectum, 2010, 53(4):486-495.
10.	Jarrar A, Church J. Advancement flap repair:a good option for com-plex anorectal fistulas. Dis Colon Rectum, 2011, 54(12):1537-1541.
11.	Mizrahi N, Wexner SD, Zmora O, et al. Endorectal advancement flap:are there predictors of failure?. Dis Colon Rectum, 2002, 45(12):1616-1621.
12.	Sonoda T, Hull T, Piedmonte MR, et al. Outcomes of primary repair of anorectal and rectovaginal fistulas using the endorectal advancement flap. Dis Colon Rectum, 2002, 45(12):1622-1628.
13.	竺平, 谷云飞. 经直肠推移瓣技术在肛瘘治疗中的应用. 中华胃肠外科杂志, 2013, 16(7):696-697.
14.	Fichera A, Michelassi F. Surgical treatment of Crohn's disease. J Gastrointest Surg, 2007, 11(6):791-803.
15.	谷云飞. 肛周克罗恩病的外科处理. 中国中西医结合学会. 第十六届中国中西医结合学会大肠肛门病专业委员会学术会议论文汇编, 广州:中国中西医结合学会, 2013:345-349.
16.	Halligan S, Stoker J. Imaging of fistula in ano. Radiology, 2006, 239(1):18-33.
17.	徐民民, 王浩, 谷云飞. 治疗肛周克罗恩病的经验. 光明中医, 2014, 29(12):2503-2505.

1. Schwartz DA, Loftus EV Jr, Tremaine WJ, et al. The natural history of fistulizing Crohn's disease in Olmsted County, Minnesota. Gastroenterology, 2002, 122(4):875-880.
2. 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.
3. El-Gazzaz G, Hull T, Church JM. Biological immunomodulators improve the healing rate in surgically treated perianal Crohn's fistulas. Colorectal Dis, 2012, 14(10):1217-1223.
4. Present DH, Rutgeerts P, Targan S, et al. Infliximab for the treat-ment of fistulas in patients with Crohn's disease. N Engl J Med, 1999, 340(18):1398-1405.
5. Stringer EE, Nicholson TJ, Armstrong D. Efficacy of topical metronidazole (10 percent) in the treatment of anorectal Crohn's disease. Dis Colon Rectum, 2005, 48(5):970-974.
6. 杨柏霖, 林秋, 陈红锦, 等. 英夫利昔单抗联合手术治疗克罗恩病肛瘘的临床疗效. 中华胃肠外科杂志, 2013, 16(4):323-327.
7. 杨柏霖, 竺平, 孙桂东. 克罗恩病肛瘘的诊断与治疗. 世界华人消化杂志, 2009, 17(20):2058-2063.
8. Marchesa P, Hull TL, Fazio VW. Advancement sleeve flaps for treatment of severe perianal Crohn's disease. Br J Surg, 1998, 85(12):1695-1698.
9. Soltani A, Kaiser AM. Endorectal advancement flap for cryptoglan-dular or Crohn,s fistula-in-ano. Dis Colon Rectum, 2010, 53(4):486-495.
10. Jarrar A, Church J. Advancement flap repair:a good option for com-plex anorectal fistulas. Dis Colon Rectum, 2011, 54(12):1537-1541.
11. Mizrahi N, Wexner SD, Zmora O, et al. Endorectal advancement flap:are there predictors of failure?. Dis Colon Rectum, 2002, 45(12):1616-1621.
12. Sonoda T, Hull T, Piedmonte MR, et al. Outcomes of primary repair of anorectal and rectovaginal fistulas using the endorectal advancement flap. Dis Colon Rectum, 2002, 45(12):1622-1628.
13. 竺平, 谷云飞. 经直肠推移瓣技术在肛瘘治疗中的应用. 中华胃肠外科杂志, 2013, 16(7):696-697.
14. Fichera A, Michelassi F. Surgical treatment of Crohn's disease. J Gastrointest Surg, 2007, 11(6):791-803.
15. 谷云飞. 肛周克罗恩病的外科处理. 中国中西医结合学会. 第十六届中国中西医结合学会大肠肛门病专业委员会学术会议论文汇编, 广州:中国中西医结合学会, 2013:345-349.
16. Halligan S, Stoker J. Imaging of fistula in ano. Radiology, 2006, 239(1):18-33.
17. 徐民民, 王浩, 谷云飞. 治疗肛周克罗恩病的经验. 光明中医, 2014, 29(12):2503-2505.

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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

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