摘要
目的本研究旨在评估手术联合英夫利昔单抗(IFX)治疗肛周瘘管性克罗恩病(PFCD)后的再次手术情况及分析相关风险因素。方法纳入2010年7月至2017年1月于南京中医药大学附属医院肛肠科接受手术联合IFX治疗的117例PFCD患者作为研究对象,分析患者治疗后到随访终点接受再次手术的影响因素。结果 117例患者中男性84例、女性33例,中位年龄24.0(20.0～29.0)岁,91%(106/117)的患者为复杂性肛瘘。88%(103/117)的患者接受挂线引流手术,56%(65/117)的患者接受了3次以上的IFX维持治疗。中位随访时间36.0(23.5～58.5)个月,随访终点共有57例(49%)患者达到临床缓解,36例(30.8%)患者需要再次手术。多因素Logistic回归分析结果提示伴有初始脓肿、IFX维持治疗3次以上是肛周瘘管性克罗恩病患者联合IFX治疗后需要再次手术的独立风险因素。结论手术联合IFX是一种治疗复杂性PFCD的合理有效的方案,临床治疗应注重对伴有初始脓肿以及IFX维持治疗超过3次等风险因素的防控和管理。
Objectives To investigate the risk of influencing factors for reoperation in patients with perianal fistulizing Crohn’s disease (PFCD) who underwent combination of surgery and infliximab (IFX) therapy. Methods 117 patients with PFCD treated at Department of Anorectal Surgery, The Affiliated Hospital of Nanjing University of Chinese Medicine, between July 2010 and January 2017 with combination of surgery and IFX therapy were selected as study subjects. The independent risk factors for reoperation from completion of treatment until end of follow-up were analyzed. Results There wew 84 men and 33 women in a total number of 117 patients recruited. Median age was 24.0 (20.0~29.0) years old. 91%(106/117) of the patients were with complex anal fistula and 88%(103/117) received placement of draining seton. 56%(65/117) of the patients received more than 3 courses of IFX maintenance therapy. Median follow-up duration was 36.0 (23.5~58.5) months. At the end of follow-up, 57 (49%) patients achieved clinical remission and 36 (30.8%) required reoperation. Multivariate Logistic regression showed that abscess as one of the initial symptoms and more than 3 courses of IFX maintenance therapy were independent risk factors for reoperation in patients with PFCD who received surgery and IFX combination therapy. Conclusion Surgery combined with IFX was an effective therapy for treating complex PFCD. Attentions and prophylactic management should be given to patients with abscess as one of the initial symptorns and those who received more than 3 courses of IFX maintenance therapy.
作者
竺平
杨柏霖
孙金芳
陈红锦
刘玥
乔立超
张梦慈
章俊彪
沈伟
谷云飞
Zhu Ping;Yang Bolin;Sun Jinfang;Chen Hongjin;Liu Yue;Qiao Lichao;Zhang Mengci;Zhang Junbiao;Shen Wei;Gu Yunfei(Department of Anorectal Surgery, The Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing 210029, Jiangsu,China;Key Laboratory of Environmental Medicine Engineering, Ministry of Education, School of Public Health, Southeast University,Nanjing 210009, Jiangsu, China)
出处
《结直肠肛门外科》
2019年第1期24-28,33,共6页
Journal of Colorectal & Anal Surgery
基金
江苏省中医药局项目(YB201805)
