不同时机拆除挂线对手术联合英夫利昔单抗治疗克罗恩病肛瘘患者预后的影响  

Effect of Seton Removal at Different Times on Prognosis of Crohns Disease Patients with Anal Fistula Treated with Surgery Combined with Infliximab

作　　者：刘宗剑 袁和学[1] 潘春来[1] LIU Zong-jian;YUAN He-rue;PAN Chun-lai(Shenyang Hospital of Coloproctology,Shenyang,Liaoning 110002)

机构地区：[1]沈阳市肛肠医院,辽宁沈阳110002

出　　处：《中国肛肠病杂志》2025年第2期47-50,共4页Chinese Journal of Coloproctology

摘　　要：目的:探讨克罗恩病肛瘘患者经手术挂线引流并应用英夫利昔单抗(IFX)治疗后拆线的最佳时机。方法:前瞻性收集我院2015年5月至2021年11月收治的符合入组标准的克罗恩病肛瘘患者共62例,随机分为观察组与治疗组,其中31例在第4次IFX治疗(第14周)后拆除挂线(观察组),31例在第3次IFX治疗(第6周)后拆除挂线(对照组)。比较2组不同时间点白细胞计数(WBC)、C反应蛋白(CRP)水平、红细胞沉降率(ESR)及瘘管闭合情况。结果:观察组拆线后第8周(IFX治疗第22周)瘘管闭合率(71.0%)显著高于同时间对照组(54.8%),P<0.05;IFX治疗第30周,观察组闭合率(74.2%)亦高于对照组(58.1%),P<0.05。炎症控制方面,对照组于第6周(拆线时)WBC、CRP、ESR降至低点,第14周反弹性升高(均P<0.05),之后逐渐降低。观察组拆线时间延至第14周,其炎症指标在拆线时控制更稳定;第22周(拆线后8周)反弹性升高,其中CRP、ESR较第14周波动的差异有统计学意义(P<0.05),WBC波动差异无统计学意义(P>0.05);之后逐渐降低。2组拆线后第8周WBC、CRP、ESR比较差异均无统计学意义(P>0.05),但观察组各指标均低于对照组。结论:第14周拆线组比第6周拆线组瘘管闭合率更高,闭合更快,且拆线后炎症指标波动更小,对于合并感染的克罗恩病肛瘘患者,将挂线保留至第4次IFX治疗(第14周)后拆除更好。Objective To explore the optimal time for removing seton in Crohn's disease patients with perianal fistulas after surgical seton drainage and treatment with infliximab(IFX).Methods A total of 62 Crohn's disease patients with perianal fistulas who met the inclusion criteria and were admitted to our hospital from May 2015 to November 2021 were prospectively collected and randomly divided into the observation group and the treatment group.Among them,31 cases had the seton removed after the 4th IFX treatment(at the 14th week)(in the observation group),and 31 cases had the seton removed after the 3rd IFX treatment(at the 6th week)(in the control group).The white blood cell count(WBC),C-reactive protein(CRP),erythrocyte sedimentation rate(ESR),and fistula closure at different time points were compared between the two groups.:Results At the 8th week after seton removal(the 22nd week of IFX treatment),the fistula closure rate of the observation group(71.0%)was significantly higher than that of the control group(54.8%)at the same time(P<0.05).At the 30th week of IFX treatment,the closure rate of the observation group(74.2%)was also higher than that of the control group(58.1%)(P<O.05).In terms of inflammation control,the WBC,CRP,and ESR of the control group dropped to a low level at the 6th week(when the seton was removed)and rebounded at the 14th week(all P<0.05),then gradually decreased.The seton removal time of the observation group was delayed to the 14th week,and its inflammatory indicators were more stable when the seton was removed.At the 22nd week(8 weeks after seton removal),there was a rebound increase,among which the fluctuation of CRP and ESR was significantly different from that at the 14th week(P<0.05),but there was no significant difference in the fluctuation of WBC(P>O.05),and then gradually decreased.There were no statistically significant differences in the WBC,CRP,and ESR between the two groups at the 8th week after seton removal(P>0.05),but each index in the observation group was lower than that in the

关 键 词：克罗恩病肛瘘 英夫利昔单抗 不同时机 拆线 预后 

分 类 号：R574.62[医药卫生—消化系统]