Department of Gastroenterology, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia.
Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia.
ANZ J Surg. 2023 May;93(5):1162-1168. doi: 10.1111/ans.18231. Epub 2023 Jan 19.
Crohn's perianal fistulas are often refractory to standard management. Fat graft injections are hypothesised to improve fistula healing rates. We evaluated the treatment efficacy of fat graft injections for Crohn's perianal fistulas in a systematic review (PRISMA).
We completed database searches of MEDLINE (Ovid), Embase, and PubMed. All studies published in English in full text or abstract, from January 2001 to August 2021, evaluating fat graft injections for Crohn's perianal fistulas were selected. Included randomized controlled trials, single-arm intervention trials, cohort studies, and case series; excluded single case reports. Primary outcome was pooled clinical healing, defined as non-draining treated fistulas, or closure, defined as closure of treated fistulas. Secondary outcomes were clinical healing, clinical closure, radiologic response, and adverse events.
Of 1258 publications identified, 891 articles were assessed for eligibility, and 107 relevant for manuscript review. Forty-nine patients received fat graft injections for Crohn's perianal fistulas across four single-arm intervention trials. Clinical healing or closure was achieved in 74% in a pooled single-arm meta-analysis (95% confidence interval: 57%, 85%), with moderate heterogeneity between studies. Clinical healing was achieved in 20% and 60% at 3 and 12 months, respectively. Clinical closure was achieved in 83% at 6 months. Variable parameters were used to define radiologic response, with success rates from 20% to 67%. Minimal adverse events were reported.
Fat graft injections show promise as a novel treatment for Crohn's perianal fistulas in this systematic review and meta-analysis. Assessment in controlled matched studies is warranted.
克罗恩病肛周瘘管通常对标准治疗方法有抗性。脂肪移植注射被假设可以提高瘘管愈合率。我们通过系统评价（PRISMA）评估了脂肪移植注射治疗克罗恩病肛周瘘管的疗效。
我们在 MEDLINE（Ovid）、Embase 和 PubMed 数据库中进行了检索。选择了 2001 年 1 月至 2021 年 8 月发表的全部以英文全文或摘要形式评估脂肪移植注射治疗克罗恩病肛周瘘管的研究。纳入了随机对照试验、单臂干预试验、队列研究和病例系列研究；排除了单病例报告。主要结局是汇总的临床愈合，定义为无引流的治疗瘘管，或闭合，定义为治疗瘘管的闭合。次要结局是临床愈合、临床闭合、放射学反应和不良事件。
在 1258 篇文献中，有 891 篇文献被评估为符合条件，有 107 篇文献与手稿审查相关。四项单臂干预试验中有 49 例患者接受了脂肪移植注射治疗克罗恩病肛周瘘管。在汇总的单臂meta 分析中，74%（95%置信区间：57%，85%）的患者达到了临床愈合或闭合，研究之间存在中度异质性。分别有 20%和 60%的患者在 3 个月和 12 个月时达到了临床愈合。6 个月时达到临床闭合的患者占 83%。使用不同的参数定义了放射学反应，成功率从 20%到 67%不等。报告的不良事件很少。
在本系统评价和 meta 分析中，脂肪移植注射显示出作为一种新型治疗克罗恩病肛周瘘管的方法有前景。需要在对照匹配研究中进行评估。
