St Mark's Hospital, Imperial College London, UK.
Aliment Pharmacol Ther. 2011 Jan;33(1):5-22. doi: 10.1111/j.1365-2036.2010.04486.x. Epub 2010 Oct 29.
Crohn's anal fistulas are common and cause considerable morbidity. Their management is often difficult; medical and surgical treatments rarely lead to true healing with frequent recurrence and complications.
To examine medical treatments previously and currently used, surgical techniques and the important role of optimal imaging.
We conducted a literature search in the Pub Med database using Crohn's, Anal Fistula, Surgery, Imaging and Medical Treatment as search terms.
Antibiotics and immunosuppressants have a role, but slow initial response, side effects and relatively low remission rates of up to around a third with frequent recurrence limit their value. Long-term infliximab produces clinical remission in 36-58% of patients with combined medical and surgical management achieving optimal outcomes. Traditional and newer surgical procedures often have a high rate of recurrence with a significant risk of temporary or, in up to 10% of cases, permanent stomas, incontinence and unhealed or slowly healing wounds in 30%.
Management of Crohn's anal fistulas remains challenging. Established principles are to drain infection, use setons as required, aggressively manage active proctitis, give antibiotics, immunosuppressants and employ anti-TNFα therapy, and they demand significant co-operation between gastroenterologists and surgeons.
克罗恩病性肛瘘较为常见，可导致严重的发病率。其治疗通常较为困难，药物和手术治疗很少能真正治愈，且常复发并伴有多种并发症。
探讨既往和目前应用的药物治疗、手术技术以及最佳影像学检查的重要作用。
我们在 Pub Med 数据库中使用“克罗恩病”“肛门瘘”“手术”“影像学”“药物治疗”作为检索词进行文献检索。
抗生素和免疫抑制剂有一定作用，但初始反应较慢、副作用以及缓解率相对较低（约 1/3）且易复发限制了其应用。长期应用英夫利昔单抗联合药物和手术治疗可使 36%-58%的患者获得临床缓解。传统和新型手术方法常易复发，有形成临时或（高达 10%）永久性造口、失禁和未愈合或愈合缓慢的伤口的风险，其 30%的患者存在上述情况。
克罗恩病性肛瘘的治疗仍然具有挑战性。目前的治疗原则是引流感染、必要时使用挂线、积极治疗活动性直肠炎、给予抗生素、免疫抑制剂和抗 TNF-α 治疗，这需要胃肠病学家和外科医生之间的密切合作。
