A preliminary clinical efficacy analysis of local injection of high concentration of glucose when removing setons of perianal fistulizing in Crohn’s disease_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

XU Minmin ¹ , WANG Hao ¹ , ZHU Ping ² , GU Yunfei ² , CHEN Yiqi ¹ , CHEN Hongjin ¹ , LI Youran ¹ ,  ZENG Li ²

1. Department of Colorectal Surgery, The Affiliated Hospital of Nanjing University of Chinese Medicine, Jiangsu Provincial Hospital of Traditional Chinese Medicine, Nanjing 210000, P. R. China;
2. The First Clinical Medical College of Nanjing University of Chinese Medicine, Nanjing 210000, P. R. China;

Corresponding?author：

ZENG Li, Email: zengbingli@163.com

Keywords：

Crohn’s disease; anal fistula; local injection of high concentration of glucose; infliximab; seton; effect

DOI：

10.7507/1007-9424.201711050

Video：

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Objective To explore the effect of local injection of high concentration of glucose when removing setons of perianal fistulizing in Crohn’s disease (CD). Methods Thirty cases of CD combined with anal fistula admitted to the Affiliated Hospital of Nanjing University of Chinese Medicine from August 2015 to July 2017 were collected prospectively, 12 cases were divided into experimental group and 18 cases were divided into control group. Cases of the experimental group received demolition of drainage seton+IFX+local injection of high concentration of glucose treatment, cases of the control group received the drainage setons removing+IFX only. Before treatment, and at 6, 14, 22, and 30 weeks after IFX treatment, the laboratory indicators of the 2 groups were detected, and BMI, Crohn’s diseaseactivity index (CDAI), perianal disease activity index (PDAI), and clinical efficacy were evaluated. Results Therewas no significant difference on the group effect and interaction of group and time (P>0.05), but time (P<0.05). Both in the experimental group and the control group, compared with before treatment group, the counts of WBC and platelet, levels of C reaction protein (CRP) and erythrocyte sedimentation rate (ESR), CDAI, and PDAI at 6 months after IFX therapy decreased and maintained at the latter period, but the level of hemoglobin (Hb) and BMI increased at 6 weeks after IFX therapy and maintained at the latter period. On the clinical effect, there was no significant difference at the time points of 14, 22, and 30 weeks of IFX therapy (P>0.05). Conclusion The treatment of local injection of high concentration of glucose when removing setons has not shown any positive effect to CD combined with anal fistula, this conclusion needs to be further studied.

Citation： XU Minmin, WANG Hao, ZHU Ping, GU Yunfei, CHEN Yiqi, CHEN Hongjin, LI Youran, ZENG Li. A preliminary clinical efficacy analysis of local injection of high concentration of glucose when removing setons of perianal fistulizing in Crohn’s disease. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2018, 25(6): 714-720. doi: 10.7507/1007-9424.201711050 Copy

1.	Rozpondek P, Zwolińska-Wcis?o M, Przybylska M, et al. Effectiveness of anti-TNF alpha antibodies in treatment of fistulizing Crohn’s disease. Przegl Lek, 2011, 68(9): 602-605.
2.	Caprilli R, Gassull MA, Escher JC, et al. European evidence based consensus on the diagnosis and management of Crohn’s disease: special situations. Gut, 2006, 55 Suppl 1: i36-i58.
3.	Gionchetti P, Dignass A, Danese S, et al. 3^rd European evidence-based consensus on the diagnosis and management of Crohn’s disease 2016: part 2: surgical management and special situations. J Crohns Colitis, 2017, 11(2): 135-149.
4.	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.
5.	Molan PC. The evidence supporting the use of honey as a wound dressing. Int J Low Extrem Wounds, 2006, 5(1): 40-54.
6.	Paine E, Shen B. Endoscopic therapy in inflammatory bowel diseases (with videos). Gastrointest Endosc, 2013, 78(6): 819-835.
7.	中華醫學會消化病學分會炎癥性腸病學組. 炎癥性腸病診斷與治療的共識意見 (2012 年·廣州). 胃腸病學, 2012, 17(12): 763-781.
8.	王浩, 徐民民, 竺平, 等. 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. 中國普外基礎與臨床雜志, 2017, 24(11): 1380-1383.
9.	歐強, 谷云飛, 陳邑歧, 等. 保留括約肌掛線法治療克羅恩病肛瘺的臨床療效評價 (附 22 例報道). 中國普外基礎與臨床雜志, 2014, 21(4): 479-481.
10.	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.
11.	中華醫學會消化病學分會炎癥性腸病學組. 炎癥性腸病營養支持治療專家共識 (2013·深圳). 中華內科雜志, 2013, 52(12): 1082-1087.
12.	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.
13.	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.
14.	李悠然, 谷云飛, 練磊.世界胃腸病組織克羅恩病肛瘺專家共識. 中華胃腸外科雜志, 2015, 18(7): 726-729.
15.	王俊珊, 劉占舉. 克羅恩病所致肛瘺的診治進展. 醫學與哲學, 2016, 37(16): 54-56.
16.	Hyder SA, Travis SP, Jewell DP, et al. Fistulating anal Crohn’s disease: results of combined surgical and infliximab treatment. Dis Colon Rectum, 2006, 49(12): 1837-1841.
17.	Tanaka S, Matsuo K, Sasaki T, et al. Clinical advantages of combined seton placement and infliximab maintenance therapy for perianal fistulizing Crohn’s disease: when and how were the seton drains removed? Hepatogastroenterology, 2010, 57(97): 3-7.
18.	Al-Maawali AK, Nguyen P, Phang PT. Modern treatments and stem cell therapies for perianal Crohn’s fistulas. Can J Gastroenterol Hepatol, 2016, 2016: 1651570.
19.	張喆, 秦芳芳, 楊俊, 等. 干細胞移植治療克羅恩病肛瘺的研究進展. 國際消化病雜志, 2017, 37(1): 8-11.
20.	Ciccocioppo R, Gallia A, Sgarella A, et al. Long-term follow-up of Crohn disease fistulas after local injections of bone marrow-derived mesenchymal stem cells. Mayo Clin Proc, 2015, 90(6): 747-755.
21.	Alessandroni L, Kohn A, Cosintino R, et al. Local injection of infliximab in severe fistulating perianal Crohn’s disease: an open uncontrolled study. Tech Coloproctol, 2011, 15(4): 407-412.
22.	Tonelli F, Giudici F, Asteria CR. Effectiveness and safety of local adalimumab injection in patients with fistulizing perianal Crohn’s disease: a pilot study. Dis Colon Rectum, 2012, 55(8): 870-875.
23.	Vlcekova P, Krutakova B, Takac P, et al. Alternative treatment of gluteofemoral fistulas using honey: a case report. Int Wound J, 2012, 9(1): 100-103.
24.	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.
25.	朱威, 胡福良, 李英華, 等. 蜂蜜的抗菌機理及其抗菌效果的影響因素. 天然產物研究與開發, 2004, 16(4): 372-375.

1. Rozpondek P, Zwolińska-Wcis?o M, Przybylska M, et al. Effectiveness of anti-TNF alpha antibodies in treatment of fistulizing Crohn’s disease. Przegl Lek, 2011, 68(9): 602-605.
2. Caprilli R, Gassull MA, Escher JC, et al. European evidence based consensus on the diagnosis and management of Crohn’s disease: special situations. Gut, 2006, 55 Suppl 1: i36-i58.
3. Gionchetti P, Dignass A, Danese S, et al. 3^rd European evidence-based consensus on the diagnosis and management of Crohn’s disease 2016: part 2: surgical management and special situations. J Crohns Colitis, 2017, 11(2): 135-149.
4. 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.
5. Molan PC. The evidence supporting the use of honey as a wound dressing. Int J Low Extrem Wounds, 2006, 5(1): 40-54.
6. Paine E, Shen B. Endoscopic therapy in inflammatory bowel diseases (with videos). Gastrointest Endosc, 2013, 78(6): 819-835.
7. 中華醫學會消化病學分會炎癥性腸病學組. 炎癥性腸病診斷與治療的共識意見 (2012 年·廣州). 胃腸病學, 2012, 17(12): 763-781.
8. 王浩, 徐民民, 竺平, 等. 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. 中國普外基礎與臨床雜志, 2017, 24(11): 1380-1383.
9. 歐強, 谷云飛, 陳邑歧, 等. 保留括約肌掛線法治療克羅恩病肛瘺的臨床療效評價 (附 22 例報道). 中國普外基礎與臨床雜志, 2014, 21(4): 479-481.
10. 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.
11. 中華醫學會消化病學分會炎癥性腸病學組. 炎癥性腸病營養支持治療專家共識 (2013·深圳). 中華內科雜志, 2013, 52(12): 1082-1087.
12. 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.
13. 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.
14. 李悠然, 谷云飛, 練磊.世界胃腸病組織克羅恩病肛瘺專家共識. 中華胃腸外科雜志, 2015, 18(7): 726-729.
15. 王俊珊, 劉占舉. 克羅恩病所致肛瘺的診治進展. 醫學與哲學, 2016, 37(16): 54-56.
16. Hyder SA, Travis SP, Jewell DP, et al. Fistulating anal Crohn’s disease: results of combined surgical and infliximab treatment. Dis Colon Rectum, 2006, 49(12): 1837-1841.
17. Tanaka S, Matsuo K, Sasaki T, et al. Clinical advantages of combined seton placement and infliximab maintenance therapy for perianal fistulizing Crohn’s disease: when and how were the seton drains removed? Hepatogastroenterology, 2010, 57(97): 3-7.
18. Al-Maawali AK, Nguyen P, Phang PT. Modern treatments and stem cell therapies for perianal Crohn’s fistulas. Can J Gastroenterol Hepatol, 2016, 2016: 1651570.
19. 張喆, 秦芳芳, 楊俊, 等. 干細胞移植治療克羅恩病肛瘺的研究進展. 國際消化病雜志, 2017, 37(1): 8-11.
20. Ciccocioppo R, Gallia A, Sgarella A, et al. Long-term follow-up of Crohn disease fistulas after local injections of bone marrow-derived mesenchymal stem cells. Mayo Clin Proc, 2015, 90(6): 747-755.
21. Alessandroni L, Kohn A, Cosintino R, et al. Local injection of infliximab in severe fistulating perianal Crohn’s disease: an open uncontrolled study. Tech Coloproctol, 2011, 15(4): 407-412.
22. Tonelli F, Giudici F, Asteria CR. Effectiveness and safety of local adalimumab injection in patients with fistulizing perianal Crohn’s disease: a pilot study. Dis Colon Rectum, 2012, 55(8): 870-875.
23. Vlcekova P, Krutakova B, Takac P, et al. Alternative treatment of gluteofemoral fistulas using honey: a case report. Int Wound J, 2012, 9(1): 100-103.
24. 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.
25. 朱威, 胡福良, 李英華, 等. 蜂蜜的抗菌機理及其抗菌效果的影響因素. 天然產物研究與開發, 2004, 16(4): 372-375.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

A preliminary clinical efficacy analysis of local injection of high concentration of glucose when removing setons of perianal fistulizing in Crohn’s disease

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