Department of Colorectal Surgery, St Vincent's Hospital, Melbourne, Victoria, Australia.
Colorectal Dis. 2011 Feb;13(2):171-6. doi: 10.1111/j.1463-1318.2009.02092.x.
Severe perianal Crohn's disease remains an uncommon but important indication for faecal diversion (FD). The advent of biological therapy such as infliximab for Crohn's disease is considered to have improved the outcome for these patients. The aim of this study was to assess the outcome of patients undergoing FD for perianal Crohn's disease and the impact of biological therapy (infliximab).
Retrospective chart review was undertaken of patients who underwent FD for management of perianal Crohn's disease at two tertiary centres between 1990 and 2007. Patient demographics, disease extent and use of biological therapy were recorded. Subsequent surgery was assessed. The impact of infliximab on rates of proctocolectomy and restoration of intestinal continuity was assessed.
Twenty-one patients (one male, 20 female), median age 34 years (range 21-67 years), underwent FD for perianal Crohn's disease. At a median follow-up time of 22 months (range 4-121 months), four patients had undergone stoma closure, 11 had had proctocolectomy and six had a stoma in situ. The effects of the procedure on severity of perianal disease were no effect in four (19%), temporary improvement in six (29%), initial improvement with later plateau in seven (33%) and healing in four patients (19%). Eleven patients (52%) received infliximab. In this group, four underwent proctocolectomy and two had intestinal continuity restored. This was not significantly different from the noninfliximab group.
Patients undergoing FD for perianal Crohn's disease have <20% likelihood of restoration of intestinal continuity. This is not improved with biological therapy.
严重的肛周克罗恩病仍然是粪便转流术（FD）的一种不常见但重要的适应证。生物治疗（如英夫利昔单抗）的出现被认为改善了这些患者的预后。本研究旨在评估接受 FD 治疗肛周克罗恩病的患者的结局，以及生物治疗（英夫利昔单抗）的影响。
对 1990 年至 2007 年在两个三级中心接受 FD 治疗肛周克罗恩病的患者进行回顾性图表审查。记录患者的人口统计学、疾病范围和生物治疗的使用情况。评估后续手术。评估英夫利昔单抗对直肠结肠切除术和恢复肠道连续性的影响。
21 例患者（1 例男性，20 例女性），中位年龄 34 岁（范围 21-67 岁），因肛周克罗恩病接受 FD。中位随访时间为 22 个月（范围 4-121 个月），4 例患者行造口关闭术，11 例行直肠结肠切除术，6 例原位造口。该手术对肛周疾病严重程度的影响为：4 例（19%）无效果，6 例（29%）暂时改善，7 例（33%）初始改善后稳定，4 例（19%）治愈。11 例（52%）患者接受英夫利昔单抗治疗。在这组中，4 例接受了直肠结肠切除术，2 例恢复了肠道连续性。这与非英夫利昔单抗组无显著差异。
接受 FD 治疗肛周克罗恩病的患者恢复肠道连续性的可能性<20%。生物治疗不能改善这种情况。
