Tanaka Shinnosuke, Matsuo Katsuichi, Sasaki Takamitsu, Nakano Masahiko, Sakai Koutarou, Beppu Richiko, Yamashita Yuichi, Maeda Kazuhiro, Aoyagi Kunihiko
Department of Gastroenterological Surgery, Fukuoka University, School of Medicine Nanakuma 7-45-1, Jonan-ku, Fukuoka 814-0180, Japan.
Hepatogastroenterology. 2010 Jan-Feb;57(97):3-7.
BACKGROUND/AIMS: Perianal fistulas are often found in patients with Crohn's Disease (CD), however, the complete management of such fistulas tends to be difficult. The aim of this study is to critically evaluate the clinical advantages of combined seton placement and infliximab maintenance therapy for perianal fistulizing CD.
Fourteen patients (9 males, 5 females) were evaluated for perianal fistulizing CD with the seton and infliximab therapy. Almost all patients were examined for the presence of either an abscess or fistulas by computed tomography (CT) and/or Magnetic Resonance Imaging (MRI) in addition to their physical findings. Seton placement was performed under general anesthesia, following the administration of inflixmab at a dose of 5 mg/kg for weeks 0, 2 and 6, and then about every 8 weeks as a maintenance therapy.
For all patients average number of inserted drains was 4.5 and the average number of infliximab infusions was 9.4 times. The mean follow-up period was 12.1 months. A redness and/or swelling in perianal lesion were seen in 12 patients, moreover, pus discharge was seen in 7 patients, and serous exudate was seen in 7 patients. After the administration of these treatments, a reversal of the redness and/or swelling was seen in the exudate and a wet-to-dry wound change was found in all patients. Furthermore, the seton drains were completely removed in 11 patients. In most patients, seton drains were completely removed after 5 rounds of infliximab infusion. Following the removal of the seton drains from all the patients, they reported their post-treatment health and well-being to be good while also reporting a good quality of life (QOL). In addition, no serious adverse events were observed.
The combined seton placement and infliximab maintenance therapy for perianal fistulizing CD was therefore found to be effective in terms of fistula closure and the removal of seton drains. This treatment modality is therefore considered to be a safe clinical procedure which improves the QOL in patients with CD.
背景/目的：肛周瘘管常见于克罗恩病（CD）患者，但此类瘘管的完整治疗往往具有挑战性。本研究旨在严格评估联合放置挂线和英夫利昔单抗维持治疗对肛周瘘管型CD的临床优势。
对14例患者（9例男性，5例女性）采用挂线和英夫利昔单抗治疗肛周瘘管型CD。除体格检查外，几乎所有患者均通过计算机断层扫描（CT）和/或磁共振成像（MRI）检查是否存在脓肿或瘘管。挂线放置在全身麻醉下进行，在第0、2和6周给予5mg/kg剂量的英夫利昔单抗，然后作为维持治疗约每8周给药一次。
所有患者平均置入引流管数量为4.5根，英夫利昔单抗平均输注次数为9.4次。平均随访期为12.1个月。12例患者肛周病变出现红肿，7例患者有脓性分泌物，7例患者有浆液性渗出物。给予这些治疗后，渗出物中的红肿消退，所有患者均出现伤口由湿变干的变化。此外，11例患者的挂线引流管完全拔除。在大多数患者中，挂线引流管在5轮英夫利昔单抗输注后完全拔除。所有患者拔除挂线引流管后，报告治疗后的健康状况良好，生活质量（QOL）也良好。此外，未观察到严重不良事件。
因此，联合放置挂线和英夫利昔单抗维持治疗肛周瘘管型CD在瘘管闭合和拔除挂线引流管方面是有效的。因此，这种治疗方式被认为是一种安全的临床程序，可改善CD患者的生活质量。
