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_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

 徐民民 , 王浩 ,  谷云飛

江蘇省中醫院肛腸科（江蘇南京 210029）;

Corresponding?author：

谷云飛, Email: guyunfei127@126.com

Keywords：

克羅恩病肛瘺; 英夫利昔單抗; 直腸推移黏膜瓣

DOI：

10.7507/1007-9424.20150290

Video：

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目的對英夫利昔單抗聯合直腸推移黏膜瓣治療克羅恩病肛瘺的臨床療效和安全性進行初步探討。方法回顧性分析江蘇省中醫院2011年6月至2014年5月期間收治的行英夫利昔單抗聯合直腸推移黏膜瓣治療的10例克羅恩病肛瘺患者的臨床資料，總結患者的肛瘺愈合情況、肛門功能以及治療過程中的不良反應。結果 10例患者中有9例患者的瘺管近期閉合，1例患者術后發生黏膜瓣感染。10例患者的瘺管閉合時間為術后1～4周（平均2周）。術后所有患者的肛門自制功能較術前均無明顯改變，且所有患者在治療過程中均未發生不良事件。術后10例患者獲訪，隨訪時間6個月～3年，中位數為12個月。隨訪期間，有1例患者于術后10個月發生肛瘺復發。結論英夫利昔單抗聯合直腸推移黏膜瓣治療克羅恩病肛瘺較為安全，且有一定療效。

Citation： 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. 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.	楊柏霖, 林秋, 陳紅錦, 等. 英夫利昔單抗聯合手術治療克羅恩病肛瘺的臨床療效. 中華胃腸外科雜志, 2013, 16(4):323-327.
7.	楊柏霖, 竺平, 孫桂東. 克羅恩病肛瘺的診斷與治療. 世界華人消化雜志, 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, 谷云飛. 經直腸推移瓣技術在肛瘺治療中的應用. 中華胃腸外科雜志, 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.	谷云飛. 肛周克羅恩病的外科處理. 中國中西醫結合學會. 第十六屆中國中西醫結合學會大腸肛門病專業委員會學術會議論文匯編, 廣州:中國中西醫結合學會, 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, 谷云飛. 治療肛周克羅恩病的經驗. 光明中醫, 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. 楊柏霖, 林秋, 陳紅錦, 等. 英夫利昔單抗聯合手術治療克羅恩病肛瘺的臨床療效. 中華胃腸外科雜志, 2013, 16(4):323-327.
7. 楊柏霖, 竺平, 孫桂東. 克羅恩病肛瘺的診斷與治療. 世界華人消化雜志, 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, 谷云飛. 經直腸推移瓣技術在肛瘺治療中的應用. 中華胃腸外科雜志, 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. 谷云飛. 肛周克羅恩病的外科處理. 中國中西醫結合學會. 第十六屆中國中西醫結合學會大腸肛門病專業委員會學術會議論文匯編, 廣州:中國中西醫結合學會, 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, 谷云飛. 治療肛周克羅恩病的經驗. 光明中醫, 2014, 29(12):2503-2505.

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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

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