Schwandner Oliver
Abteilung für Proktologie, Krankenhaus Barmherzige Brüder, Regensburg, Deutschland.
Zentralbl Chir. 2023 Jun;148(3):220-227. doi: 10.1055/a-2063-3673. Epub 2023 Jun 2.
Despite progress in multidisciplinary diagnostic and therapeutic strategies, complex anal fistulas associated with Crohn's disease remain a challenge for both medical and surgical management. Conventional surgical techniques such as flap procedures or LIFT are still associated with considerable persistence and recurrence rates. Based on this background, results of stem cell therapy for Crohn's anal fistula have shown promising results and are a sphincter-preserving technique. In particular, adipose-derived, allogeneic stem cell therapy (Darvadstrocel) has shown encouraging healing rates within the randomised controlled ADMIRE-CD trial, which were reproducible in "real world" data of limited clinical studies. The current evidence has led to the integration of allogeneic stem cell therapy into international guidelines. To date, the definitive status of allogeneic stem cells in the multidisciplinary treatment algorithm for complex anal fistulas associated with Crohn's disease cannot be evaluated.
尽管在多学科诊断和治疗策略方面取得了进展,但与克罗恩病相关的复杂性肛瘘仍然是医学和外科治疗的一大挑战。传统的外科技术,如皮瓣手术或括约肌间瘘管结扎术(LIFT),其持续性和复发率仍然相当高。基于这一背景,干细胞疗法治疗克罗恩病肛瘘已显示出有前景的结果,且是一种保留括约肌的技术。特别是,脂肪来源的同种异体干细胞疗法(达沙替尼)在随机对照的ADMIRE-CD试验中显示出令人鼓舞的愈合率,这在有限临床研究的“真实世界”数据中也具有可重复性。目前的证据已促使同种异体干细胞疗法被纳入国际指南。迄今为止,同种异体干细胞在与克罗恩病相关的复杂性肛瘘多学科治疗方案中的最终地位尚无法评估。