| Background:Anal fistula is the most common perianal Crohn's disease,is in the field of refractory disease,causing great pain to the patients.However,the treatment can not simply follow the traditional method of anorectal disease surgery,otherwise it is easy to cause the failure of the operation.Although both at home and abroad for Crohn's disease and association based treatment reached a certain consensus,but opinions on the diagnosis and treatment of Crohn's disease described less anal fistula.Foreign literature supports anal fistula Seton therapy in the treatment of Crohn's disease,but no evidence of full time reported stitches.Biological agent infliximab is an effective treatment for anal fistula is clear of Crohn's disease,on the basis of the treatment,we made use of sphincter preserving thread to improve fistula closure.In addition,during the "consensus" expert anal Crohn's disease omge recommend at least infliximab induction therapy recommended to keep hanging line drainage.But when the demolition of local drainage rubber band,fistula closure rate increased after suture removal,reduce the recurrence rate,is the focus of the study.Objective:For patients with Crohn's disease first relaxation anal fistula seton drainage,biologics infliximab induced by removal of the rubber band drainage after the end of treatment,observe the closure of fistula,and the efficacy and safety of the overall treatment plan.Methods:From August 2015 to December 2016 in the Affiliated Hospital of Nanjing University of Chinese Medicine(Jiangsu Province Traditional Chinese Medicine Hospital)accepted 31 Crohn's disease patients with anal fistula Seton therapy with infliximab.After preoperative evaluation,and then with the help of rectal MR under the first line of relaxation.To infliximab started first weeks after operation(5mg/kg)induction therapy,treatment time was 0,2,6 weeks after intravenous administration,maintenance treatment time interval of 8 weeks.Before and after treatment,the CDAI,PCDAI,Wexner score,blood parameters and endoscopic findings were monitored.The end of the third infliximab treatment,assessment of patients with systemic and local symptoms,to patients with removal of anal drainage rubber band.Fifth infliximab treatment,record closure and general condition of patients with perianal fistula.Results:?The 31 patients were at the end of third infliximab therapy after the removal of the anus drainage rubber band,evaluation of the end of the fifth after treatment:14 cases healed,the healing rate was 45.2%.The other 17 cases were treated with,and the rate of PCDAI was decreased from 9.29 ± 2.96to 3.26 ± 2.35.?The patient's general condition improved significantly,CDAI was236.42±79.26,decreased to128.71 ±53.31,which was significantly lower than that before operation,the difference was statistically significant.?Inflammatory markers,WBC,neutrophils and platelets were decreased in different degree,and the difference was statistically significant.? Liver and kidney function index patients,alanine aminotransferase(ALT)by preoperative 17.19 ± 14.02to27.19± 18.91.It was a statistically significant difference;serum creatinine(CR)from preoperative 63.04± 14.30 to 56.84± 12.37,the difference was statistically significant;urea nitrogen(BUN),preoperative change and after not playing,after inspection,the difference was not statistically significant.?Preoperative and postoperative anal function score difference analysis,P value of =0.564>0.05,preoperative and postoperative scores were not statistically significant difference.The results indicated that the sphincter preserving technique had no significant effect on the anal function.?The period of follow-up,no recurrence.Conclusion:This study retained sphincter thread joint stitches time of infliximab in treatment of anal Crohn's disease was explored preliminarily.The end of the 31 CD cases of anal fistula patients were third infliximab after treatment removed anus drainage rubber band.Continue to infliximab maintenance treatment.The healing rate was 45.2%,the effective rate was 100%,which was basically the same as other studies.For protecting the anal function of patients with good,and patients with systemic symptoms,intestinal inflammation,late for laying groundwork and foundation of sphincter preserving surgery for the system of standardized treatment of anal fistula from Crohn's disease. |
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