Division of Colon and Rectal Surgery, Department of Surgery, University of Minnesota, Minneapolis, Minnesota, USA.
Colorectal Dis. 2011 Jun;13(6):678-83. doi: 10.1111/j.1463-1318.2010.02234.x. Epub 2010 Feb 15.
Surgical repair of recto-vaginal fistula (RVF) in Crohn's disease (CD) has been associated with high rates of failure. The aim of this study was to compare the outcome in patients with CD who underwent RVF surgery with or without infliximab infusion.
A retrospective review was carried out of 51 consecutive patients with CD treated for a symptomatic RVF between March 1998 and December 2004.
Fifty-one patients (mean age 39 years) underwent 65 procedures, including seton drainage (n = 35), advancement flap (n = 8), fibrin glue injection (n = 8), transperineal repair (n = 6), collagen plug placement (n = 4) and bulbocavernosus flap (n = 4). All patients were on medical treatment at the time of surgery and 26 patients had received preoperative infliximab treatment (minimum of three infusions, 5 mg/kg). Ten patients underwent preoperative diversion. At a mean follow up of 38.6 months, 27 fistulas (53%) had healed and 24 (47%) had recurred. Fistula healing occurred in 60% of patients treated with preoperative diversion, whereas 51% of nondiverted repairs were successful. Neither active proctitis nor infliximab therapy significantly affected fistula healing. Fourteen (27%) patients eventually required proctectomy.
RVF in CD is difficult to treat. Failure rates are significant despite repeated surgical interventions and concomitant medical treatment.
克罗恩病（CD）直肠阴道瘘（RVF）的手术修复与高失败率相关。本研究旨在比较接受 RVF 手术且未接受英夫利昔单抗输注与接受 RVF 手术且接受英夫利昔单抗输注的 CD 患者的结局。
对 1998 年 3 月至 2004 年 12 月期间因症状性 RVF 而接受治疗的 51 例连续 CD 患者进行回顾性分析。
51 例患者（平均年龄 39 岁）接受了 65 次手术，包括挂线引流（n = 35）、推进皮瓣（n = 8）、纤维蛋白胶注射（n = 8）、经会阴修复（n = 6）、胶原蛋白塞放置（n = 4）和球海绵体肌瓣（n = 4）。所有患者在手术时均接受药物治疗，26 例患者接受过术前英夫利昔单抗治疗（最少 3 次输注，5mg/kg）。10 例患者接受术前分流术。在平均 38.6 个月的随访中，27 个瘘管（53%）愈合，24 个瘘管（47%）复发。接受术前分流术的患者中，瘘管愈合率为 60%，而未接受分流术的修复成功率为 51%。活动性直肠炎或英夫利昔单抗治疗均未显著影响瘘管愈合。14 例（27%）患者最终需要行直肠切除术。
CD 中的 RVF 难以治疗。尽管进行了多次手术干预和联合药物治疗，但失败率仍很高。
