CAJ | 학술논문

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x2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(x2=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.
목적 비교괘선인류술연합항TNF-α단항화연합면역억제제치료극라은병합병항루적림상료효.방법 회고성분석2007년6월지2014년2월중산대학부속제륙의원수치적37례극라은병합병항루환자적림상자료.17례환자행괘선인류술연합항TNF-α단항치료(항TNF-α단항조),20례환자행괘선인류술연합면역억제제치료(면역억제제조).비교량조환자루구유합비례、루구미유합비례、항루복발비례、항루복발후재차수술비례、루구유합시간급항루복발시간.채용문진혹전화방식진행수방,수방시간절지2014년5월.계량자료채용t검험,계수자료채용x2검험.결과 항TNF-α단항조17례환자중1례사용아체목단항,기여16례사용영부리서단항.면역억제제조20례환자균사용류서표령.37례환자균획득수방,평균수방시간위19개월(3～50개월).항TNF-α단항조화면역억제제조환자루구유합비례、루구미유합비례、항루복발비례、항루복발후재차수술비례、루구유합시간급항루복발시간분별위8/17、7/17、2/17、2/2、(2.5±2.1)개월、(4.0±2.8)개월화12/20、3/20、5/20、3/5、(3.6±3.5)개월、(9.0±8.2)개월,량조비교,차이무통계학의의(x2=0.620,2.137,0.364,0.018,t=-1.035,-0.619,P＞0.05).결론 괘선인류술시치료극라은병합병항루유효적외과치료방법,연합항TNF-α단항화연합면역억제제치료극라은병합병항루적효과상당.
Objective To compare the efficacies of seton drainage combined with anti TNF-α 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 Yat-Sen University from June 2007 to February 2014 were retrospectively analyzed.Seventeen patients were treated by seton drainage combined with anti TNF-α monoclonal antibody (anti TNF-α 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 out-patient examination and phone call till May 2014.The measurement data and the count data were analyzed using the t test and chi-square test,respectively.Results One patient in the anti TNF-α 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 TNF-α 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 (x2=0.620,2.137,0.364,0.018,t =-1.035,-0.619,P ＞ 0.05).Conclusions Seton drainage is effective for the treatment of Crohn's disease complicated with anal fistula.The efficacies of seton drainage combined with anti TNF-α monoclonal antibody or immunosuppressant are comparative.