Efficacy and safety of combined treatment with FiLaC TM surgery and infliximab for complex perianal fistulizing Crohn's disease
10.3760/cma.j.cn1014870-20231031-00053
- VernacularTitle:环状激光闭合手术联合英夫利西单克隆抗体治疗复杂性克罗恩病肛瘘的有效性和安全性分析
- Author:
Xiaohui WANG
1
;
Keyu QIAN
;
Cheng ZHANG
;
Ke XU
;
Jian HE
;
Mingming ZHU
;
Ye ZHANG
;
Zhe CUI
;
Dongxing CAO
Author Information
1. 上海交通大学医学院附属仁济医院宝山分院普通外科，上海 200444
- Publication Type:Journal Article
- Keywords:
Crohn's disease;
Perianal fistula;
Fistula-tract laser closure;
Infliximab;
Fistula healing
- From:
Chinese Journal of Inflammatory Bowel Diseases
2024;08(5):390-394
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To evaluate the effectiveness and safety of fistula-tract lase closure (FiLaC TM) surgery combined with the infliximab (IFX) for treating complex perianal fistulizing Crohn's disease (pfCD) . Methods:A retrospective was conducted. Patients with pfCD undergoing FiLaC TM at Renji Hospital, Shanghai Jiaotong University School of Medicine between February 2019 and August 2020 were retrospectively enrolled. The preoperative protocol included seton drainage and pharmacological induction, utilizing IFX alone or in combination with immunosuppressants. After achieving remission in CD, patients underwent definitive surgery with FiLaC TM. Clinical outcomes and adverse events such as bleeding, pain, and fecal incontinence following FiLaC TM were recorded. The Wexner fecal incontinence score and Crohn's anal fistula quality of life scale (CAF-QoL) were assessed both preoperatively and 24 months postoperatively. Results:The study included 30 patients (23 males, 7 females) with a median age of 23.6 (18.0, 30.5) years. At 24 months postoperatively, 21 patients (70.0%) achieved clinical cure; 2 patients (6.7%) showed improvement; 2 patients (6.7%) did not heal, with one eventually healing after a repeat FiLaC TM procedure and the other requiring re-seton placement; 5 patients (16.7%) relapsed and required re-seton. The Wexner fecal incontinence score at 24 months postoperatively was lower compared to preoperative scores [2.0 (1.8, 3.0) vs. 2.0 (2.0, 3.0), P = 0.001]. The postoperative CAF-QoL scores were higher as compared to the preoperative score[39.5 (33.8, 62.3) vs. 37.5 (30.0, 56.3), P = 0.03]. There were no complications such as fecal incontinence, urinary incontinence, or bleeding postoperatively. Twenty-seven patients (90%) experienced mild pain, and 1 (3.3%) reported moderate pain, all resolving without intervention. Conclusion:Combined treatment with FiLaC TM and IFX is both effective and safe for managing complex pfCD.
