Department of Colorectal Surgery, Northern General Hospital, Sheffield, UK.
Colorectal Dis. 2013 Feb;15(2):210-6. doi: 10.1111/j.1463-1318.2012.03124.x.
Perianal disease affects 33% (range 8-90%) of patients with Crohn's disease. Fistulae are often complex and their management is often difficult and unsatisfactory. This study was a retrospective assessment of a combination of surgical treatment with a standardized protocol of infliximab (IFX) therapy.
A consecutive series of patients with complex perianal Crohn's disease, presenting between January 2003 and June 2008, were included. Acute sepsis was initially treated with antibiotics and/or surgical drainage (MRI guided when appropriate) and loose seton insertion. IFX was given at 5 mg/kg, at 0, 2 and 6 weeks. End-points were complete, partial or no response. Setons were empirically removed after the second cycle of IFX.
Forty-eight patients, average age 46 (range 24-82)years, with perianal Crohn's disease were identified. Three patients stopped IFX after the second infusion, either because of allergy (two patients) or for failure to respond (one patient). Fourteen patients were given maintenance IFX at 8-weekly intervals. Results were recorded for 48 patients, of whom 14 (29%) had a complete response, 20 (42%) had a partial response and 14 (29%) had no response to treatment. Outpatient follow-up was for a median of 20 months.
Combining surgical procedures with IFX resulted in complete and partial remission in 29% and 42% of patients, respectively. No serious side effects occurred. Using a combined, intensive medico-surgical approach, good initial control of perianal disease was achieved safely.
肛门周围疾病影响 33%（8-90%的范围）克罗恩病患者。瘘管通常很复杂，其治疗往往困难且不满意。本研究回顾性评估了手术治疗联合英夫利昔单抗（IFX）治疗标准化方案的疗效。
连续纳入 2003 年 1 月至 2008 年 6 月期间出现复杂肛门周围克罗恩病的患者。急性脓毒症最初用抗生素和/或手术引流（在适当情况下进行 MRI 引导）和松散的挂线治疗。给予 IFX 5mg/kg，在 0、2 和 6 周时给予。终点为完全、部分或无反应。在第二个 IFX 周期后，经验性地去除挂线。
确定了 48 例平均年龄 46 岁（范围 24-82 岁）的肛门周围克罗恩病患者。有 3 例患者在第二次输注后停止使用 IFX，原因分别为过敏（2 例）或无反应（1 例）。14 例患者给予每 8 周一次的维持 IFX。记录了 48 例患者的结果，其中 14 例（29%）完全缓解，20 例（42%）部分缓解，14 例（29%）对治疗无反应。门诊随访中位数为 20 个月。
手术联合 IFX 治疗分别使 29%和 42%的患者达到完全和部分缓解。未发生严重不良反应。采用联合强化的内科-外科治疗方法，可安全地实现对肛门周围疾病的初始良好控制。
