Department of Colorectal Surgery, St Mark's Hospital and Academic Institute, London, UK; IBD unit, St Mark's Hospital and Academic Institute, London, UK; Department of Cardiovascular Medicine, St Mary's Hospital, London, UK.
Aliment Pharmacol Ther. 2014 Oct;40(7):741-9. doi: 10.1111/apt.12906. Epub 2014 Aug 13.
The management of perianal Crohn's fistulas represents a significant challenge. A combination of medical and surgical therapy, guided by radiology, is often required.
To review systematically the literature to assess fistula healing rates with medical treatment (anti-TNF-α therapies ± immunomodulators) or surgical treatment alone, compared with combined medical and surgical treatment in fistulising perianal Crohn's disease (CD).
The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were used. Two independent reviewers searched the literature.
Twenty-four articles were included. The total population was 1139 patients; 460 (40%) received single treatment with either medical or surgical therapy, and 679 (60%) received combined medical and surgical therapy. Eight studies compared single and combination therapy, with a total population of 797 patients (single therapy: n = 448, combination therapy: n = 349). In the single therapy group, 191/448 were in complete remission (43%). This was lower than the healing rate of the combination therapy group 180/349 (52%). No response to therapy was noted in 34% (153/448) of the single therapy group compared with 23% (80/349) of the combination group.
Combined surgical and medical (anti-TNF-α ± immunomodulators) therapy may have additional beneficial effects on perianal fistula healing in patients with Crohn's disease, compared with surgery or medical therapy alone. A well-designed Crohn's perianal fistula clinical trial is required in a multidisciplinary medical and surgical setting, with clearly defined end points of clinical (and likely patient reported outcomes) and radiological healing.
肛周克罗恩病瘘管的管理是一个重大挑战。通常需要结合放射学指导的医学和手术治疗。
系统回顾文献，评估在肛周克罗恩病（CD）患者中，与单独的医学或手术治疗相比，联合医学和手术治疗对瘘管愈合的效果。
使用系统评价和荟萃分析的首选报告项目（PRISMA）指南。两名独立的审查员检索了文献。
共纳入 24 篇文章。总人群为 1139 例患者；460 例（40%）接受了单一的医学或手术治疗，679 例（60%）接受了联合医学和手术治疗。8 项研究比较了单一和联合治疗，总人群为 797 例患者（单一治疗：n = 448，联合治疗：n = 349）。在单一治疗组中，448 例中有 191 例（43%）完全缓解。这低于联合治疗组的愈合率 180/349（52%）。在单一治疗组中，34%（153/448）的患者对治疗无反应，而联合治疗组为 23%（80/349）。
与单独手术或医学治疗相比，联合手术和医学（抗 TNF-α±免疫调节剂）治疗可能对克罗恩病患者的肛周瘘管愈合有额外的有益作用。需要在多学科的医学和手术环境中进行一项设计良好的克罗恩病肛周瘘管临床试验，明确界定临床（可能包括患者报告结果）和影像学愈合的终点。
