Chen Pingrun, She Yufen, Wang Liangfang, Li Yina, Zhang Yan
Department of Gastroenterology and Hepatology, West China Hospital, Sichuan University, Sichuan, China.
Department of Respiratory and Critical Care, West China Hospital, Sichuan University, Sichuan, China.
PLoS One. 2025 Jul 17;20(7):e0327784. doi: 10.1371/journal.pone.0327784. eCollection 2025.
Intestinal penetrating complications of Crohn's disease (CD) are challenging issues, but it is difficult to decide between medical treatment and surgery. This study aimed to evaluate the outcomes of medical and surgical therapy in patients with non-perianal fistulizing CD.
Our study aimed to evaluate and compare the effectiveness of surgery and medical treatment in CD patients with non-perianal fistulas.
This retrospective study included all CD patients with non-perianal fistulas. We evaluated the outcomes of medical and surgical therapy. Fistula closure was identified with radiological examinations or ultrasound. Cox regression analysis was subsequently performed.
Sixty patients (37 male) were included. 43.3% of the patients received biological agents as the first therapy, whereas 55% required surgery as the initial therapy, and the remaining 1 patient received azathiopurine alone. 71.7% of the patients achieved fistula closure, with a median follow-up of 32 months. Among the patients who received biologics as the initial treatment, 38.5% achieved fistula closure without the need for surgery, and 50% of the patients underwent surgery. Fistula closure was observed in 69.7% of the patients who underwent surgery as the initial treatment. Enteral nutrition before initial treatment was independently associated with fistula closure.
Although surgery occupies a crucial role in the treatment of patients with non-perianal fistulizing CD, biologics are also effective. Enteral nutrition may increase the probability of fistula closure, especially in patients who undergo surgery as the initial therapy.
克罗恩病（CD）的肠道穿透性并发症是具有挑战性的问题，但在药物治疗和手术治疗之间做出抉择很困难。本研究旨在评估非肛周瘘管性CD患者的药物治疗和手术治疗效果。
我们的研究旨在评估和比较手术治疗与药物治疗对非肛周瘘管性CD患者的有效性。
这项回顾性研究纳入了所有非肛周瘘管性CD患者。我们评估了药物治疗和手术治疗的效果。通过放射学检查或超声确定瘘管闭合情况。随后进行Cox回归分析。
纳入60例患者（37例男性）。43.3%的患者接受生物制剂作为初始治疗，而55%的患者需要手术作为初始治疗，其余1例患者仅接受硫唑嘌呤治疗。71.7%的患者实现了瘘管闭合，中位随访时间为32个月。在接受生物制剂作为初始治疗的患者中，38.5%的患者无需手术即实现了瘘管闭合，50%的患者接受了手术。在以手术作为初始治疗的患者中，69.7%观察到瘘管闭合。初始治疗前的肠内营养与瘘管闭合独立相关。
虽然手术在非肛周瘘管性CD患者的治疗中起着关键作用，但生物制剂也有效。肠内营养可能会增加瘘管闭合的概率，尤其是在以手术作为初始治疗的患者中。
