挂线引流术联合不同药物治疗克罗恩病合并肛瘘的疗效比较

Comparison of the efficacies of seton drainage combined with different drugs in the treatment of Crohn′s disease complicated with anal fistula

    摘要
  • 摘要: 目的:比较挂线引流术联合抗TNF-α单抗和联合免疫抑制剂治疗克罗恩病合并肛瘘的临床疗效。
    方法:回顾性分析2007年6月至2014年2月中山大学附属第六医院收治的37例克罗恩病合并肛瘘患者的临床资料。17例患者行挂线引流术联合抗TNFα单抗治疗(抗TNF-α单抗组)，20例患者行挂线引流术联合免疫抑制剂治疗(免疫抑制剂组)。比较两组患者瘘口愈合比例、瘘口未愈合比例、肛瘘复发比例、肛瘘复发后再次手术比例、瘘口愈合时间及肛瘘复发时间。采用门诊或电话方式进行随访，随访时间截至2014年5月。计量资料采用t检验，计数资料采用χ 2检验。
    结果:抗TNFα单抗组17例患者中1例使用阿达木单抗，其余16例使用英夫利西单抗。免疫抑制剂组20例患者均使用硫唑嘌呤。37例患者均获得随访，平均随访时间为19个月(3～50个月)。抗TNFα单抗组和免疫抑制剂组患者瘘口愈合比例、瘘口未愈合比例、肛瘘复发比例、肛瘘复发后再次手术比例、瘘口愈合时间及肛瘘复发时间分别为8/17、7/17、2/17、2/2、(2.5±2.1)个月、(4.0±2.8)个月和12/20、3/20、5/20、3/5、(3.6±3.5)个月、(9.0±8.2)个月，两组比较，差异无统计学意义(χ 2=0.620，2.137，0.364，0.018，t=-1.035，-0.619，P>0.05)。
    结论:挂线引流术是治疗克罗恩病合并肛瘘有效的外科治疗方法，联合抗TNFα单抗和联合免疫抑制剂治疗克罗恩病合并肛瘘的效果相当。

     

    Abstract: Objective:To compare the efficacies of seton drainage combined with anti TNFα monoclonal antibody or immunosuppressants in the treatment of Crohn′s disease complicated with anal fistula.
    Methods:The clinical data of 37 patients with Crohn′s disease complicated with anal fistula who were admitted to the Sixth Affiliated Hospital of Sun YatSen University from June 2007 to February 2014 were retrospectively analyzed. Seventeen patients were treated by seton drainage combined with anti TNFα monoclonal antibody (anti TNFα monoclonal antibody group) and 20 were treated by seton drainage combined with immunosuppressants (immunosuppressant group). The ratios of patients with healed and unhealed fistula, time for fistula heal, ratio of anal fistula recurrence, time for anal fistula recurrence and ratio of reoperation for anal fistula between the 2 groups were compared. Patients were followed up via outpatient examination and phone call till May 2014. The measurement data and the count data were analyzed using the t test and chisquare test, respectively.
    Results:One patient in the anti TNFα monoclonal antibody group was treated by adalimumab, and the other 16 patients were treated by infliximab. Twenty patients in the immunosuppressant group were treated by azathioprine. All the patients were followed up for a mean time of 19 months (range, 3-50 months). The ratios of patients with healed and unhealed fistula, recurrence of anal fistula, reoperation for anal fistula recurrence, time for fistula heal and time for anal fistula recurrence were 8/17, 7/17, 2/17, 2/2, (2.5±2.1)months and (4.0±2.8)months in the anti TNFα monoclonal antibody group, and 12/20, 3/20, 5/20, 3/5, (3.6±3.5) months and (9.0±8.2) months in the immunosuppressant group, with no significant difference between the 2 groups (χ 2=0.620, 2.137, 0.364, 0.018, t=-1.035,-0.619, P>0.05).
    Conclusion:Seton drainage is effective for the treatment of Crohn′s disease complicated with anal fistula. The efficacies of seton drainage combined with anti TNFα monoclonal antibody or immunosuppressant are 〖HJ*6〗comparative.

     

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