Lavy A, Weisz G, Adir Y, Ramon Y, Melamed Y, Eidelman S
Department of Gastroenterology, Rambam Medical Center, Haifa, Israel.
J Clin Gastroenterol. 1994 Oct;19(3):202-5. doi: 10.1097/00004836-199410000-00006.
Perianal involvement in Crohn's disease is common (< or = 50%), distressing, and frequently refractory to treatment. Clinical features include painful induration and stenosis, discharging fistulas, and fissures. The pathogenesis of these lesions is unclear, but local ischemia and secondary anaerobic infection may play a role. Following three sporadic reports of successful treatment with hyperbaric oxygen (HBO), we undertook a trial of this method in 10 patients with refractory perianal disease. These patients' perianal Crohn's disease had not responded to treatment that included local medications, salicylates, corticosteroids, metronidazole, or 6-mercaptopurine were treated. Treatment was administered in a hyperbaric chamber at a pressure of 2.5 atm absolute. Each session lasted 90 min, and each course consisted of 20 daily sessions. Complete healing occurred in 5 patients after one to two courses. In an additional 2, after three courses, 1 patient improved but did not heal, and 2 did not improve. No adverse effects were noted by any of the 10 patients. Follow-up of 18 months did not reveal any recurrence. These preliminary results confirm that HBO therapy is a safe and efficient therapeutic option for perianal Crohn's disease.
克罗恩病累及肛周很常见（≤50%），令人苦恼，且常常对治疗难治。临床特征包括疼痛性硬结和狭窄、有排液的瘘管及肛裂。这些病变的发病机制尚不清楚，但局部缺血和继发性厌氧菌感染可能起作用。在有3篇关于高压氧（HBO）成功治疗的散在报道后，我们对10例难治性肛周疾病患者进行了该方法的试验。这些患者的肛周克罗恩病对包括局部用药、水杨酸盐、皮质类固醇、甲硝唑或6-巯基嘌呤在内的治疗均无反应。治疗在高压舱内以绝对压力2.5个大气压进行。每次治疗持续90分钟，每个疗程包括每日20次治疗。1至2个疗程后5例患者完全愈合。另外2例患者，3个疗程后，1例改善但未愈合，2例无改善。10例患者均未观察到不良反应。18个月的随访未发现任何复发。这些初步结果证实，HBO治疗是肛周克罗恩病一种安全有效的治疗选择。
