A Study On The Clinical Characteristics,seton Removing And Healing Promotion Of Perianal Fistulizing In Crohn’s Disease

Objective Explore the clinical characteristics of perianal fistulisimg Crohn’s disease to help clinicians better identify this diease.Analyze the method of removing setons when infliximab(IFX)combined drainage setons therapy are used in the treatment of perianal fistulising Crohn’s disease.Methods A total of 139 cases of perianal fistulising Crohn’s disease who got treatment from January 2010 to January 2017 in The Affiliated Hospital of Nanjing University of Traditional Chinese Medicine were analyzed retrospectively to find the clinical characteristics.To analyze the method of removing setons,we oberve the effect of local injection of high concentration of glucose when removing setons of perianal fistulizing in Crohn’s disease and the effect of removing setons after the induction treatment of IFX.To oberve the effect of local injection of high concentration of glucose when removing setons of perianal fistulizing in Crohn’s disease,thirty cases of perianal fistulising Crohn’s disease wre prospective collected in the Affiliated Hospital of Nanjing University of Chinese Medicine from December 2015 to March 2017,21 cases were divided into experimental group and 25 cases were divided into control group.Cases of the experimental group received demolition of drainage seton+IFX+local injection of high concentration of glucose treatment,cases of the control group received the drainage setons removing+IFX only.Before treatment,and at 6,14,22,and 30 weeks after IFX treatment,the laboratory indicators of the two groups were detected,and BMI,Crohn ’s disease activity index(CDAI),perianal disease activity index(PDAI),and clinical efficacy were evaluated.To observe the effect of removing setons after the induction treatment of IFX,thirty patients of perianal fistulising Crohn’s disease in the Affiliated Hospital of Nanjing University of Chinese Medicine from August 2015 to July 2017 were analyzed retrospectively.They were treated with drainage setons followed by intravenous IFX injections according to the standard,and setons were removed after the third injection of IFX.The method of repeated measurement were adopted to record clinical symptoms,perianal manifestations,laboratory indexes,healing rate.Results The clinical characteristics of perianal fistulising Crohn’s disease were summarized as follows.The proportion of males and females in 139 patients was about 3.3:1.0,the age was(28±8)years,and 47.5%of patients had perianal fistula before CD diagnosis.The percents of patients with perianal surgery history and medication history were 64.7%and 74.1%,respectively.The ratio of L3 type(diseased position)was 49.6%.The ratios of inflammatory type(B1 type)and stenotic type(B2 type)of the disease were 51.8%and 41.0%,respectively.The complex perianal fistula accounted for 90.6%,and 31.7%of patients combined analrectal stricture.Symptoms of diarrhea were found in 46.0%of patients and perianal lesions alone in 29.5%of patients;54.0%of patients combined with abnormal BMI;64.7%of patients were in the active stage of Crohn’s disease activity index(CDAI)and 94.2%of patients were in the active period of perianal disease activity index(PDAI).The patients with erythrocyte sedimentation rate(ESR)higher than normal were 53.2%.44 cases(31.7%)of 139 perianal fistulising Crohn’s disease were associated with anorectal stenosis.Univariate analysis showed that CDAI,lesion location and age were risk factors for stenosis of CD anal fistula.Logistic regression analysis showed that mild(OR=3.908,95%CI:1.151～13.268)to moderate(OR=7.399,95%CI:1.993-27.468)CDAI and age(OR=1.061,95%CI:1.009～1.116)were independent risk factors for rectal stenosis in CD anal fistula.The results of observation of local injection of high concentration of glucose when removing setons of perianal fistulizing in Crohn’s disease were summarized as follows.Both in the experimental group and the control group,compared with before treatment,levels of ESR and HB,the counts of PLT,scores of CDAI and PDAI decreased.Of white blood cells(WBC),two groups was statistically significant at week 30(P<0.05).Of c-reactive Protein(CRP),Erythrocyte sedimentation rate(ESR),hemoglobin(HB),blood platelets(PLT),Body Mass Index(BMI),CDAI and PDAI values,there was no significant difference on the group effect and interaction of group and time(P>0.05),but time(P<0.05).On the clinical effect,there was no significant difference at the time points of 14,22,and 30 weeks of IFX therapy(P>0.05).The results of observation of removing setons after the induction treatment of IFX were summarized as follows.The differences of WBC,CRP,ESR,HB,PLT,BMI,CDAI and PDAI between post treatment and pretreatment were statistically significant(P<0.5).WBC,CRP and ESR will rerise at some time after removing the rubber band(sixth week).The closure rate of fistular at the 14th week was 53.3%,and after the follow up in the ward at 22th week and 30th week,the clinical efficacy of fistular was not statistically significant(P>0.05)at the 14th week,22thweek and 30th week.Conclusions Characteristics of patients of perianal fistulising Crohn’s disease include:young,men predominant,high prevalence of ileocolic position involvement,as well as inflammation and stenosis disease behavior.Fistula symptoms often precede the intestinal symptoms and diarrhea is the most common intestinal performance.History of perianal abscess and fistula operation are common.The anorectal stricture are complicated usually.Intestinal inflammation is active.Some patients show abnormal laboratory indicators of inflammation.This suggests that patients with perianal fistula with these clinical features should be alert to the possibility of CD,so as to avoid the consequences of blind surgery.The higher CDAI score and the older thediagnosis age,the higher the risk of rectal stenosis.The treatment of local injection of high concentration of glucose when removing setons has not shown any positive effect to CD combined with anal fistula,this conclusion needs to be further studied.IFX combined drainage setons which Was removed when the induction therapy finished can induce Cmhn’S disease remission,improve laboratory index and promote fistula closure.the clinical efficacy in short time was stable.