| Background:Anal fistula is one of the most common perianal lesions of Crohn’s disease and is a refractory disease in medical field,which brings great suffering to patients’ work and life.Because of its treatment options and the degree of disease activity is closely related,it can not simply follow the traditional method of anal fistula surgery,otherwise easily lead to surgical failure.Although the domestic and foreign basic understanding of the medical and surgical treatment of Crohn’s disease,but there is little discussion on the diagnosis and treatment of Crohn’s disease anal fistula.Therefore,how to accurately evaluate the degree of activity of Crohn’s disease anal fistula surgery in different periods and what kind of surgery and drug treatment programs is the focus of this study.Objective:1.To develop an MRI scoring system that objectively evaluates the activity of an anal fistula of Crohn’s disease;2.To screen for the best combination of medication and traditional Chinese medicine for the treatment of Crohn’s disease during anal fistula activity;3.Sphincter-saving surgery of mucosal flap sidesway to treat remission of Crohn’s disease anal fistula clinical efficacy and safety.Methods:1.Patients with newly diagnosed Crohn’s disease fistula who met the inclusion criteria were enrolled in this study.An anorectal MRI was performed for plain and enhancement MRI.The modified Van Assche MRI score was calculated and compared with PDAI,CDAI score and biological indicators.2.Retrospective analysis of different drugs combined with Chinese medicine seton therapy for active Crohn’s disease anal fistula patients,evaluate the clinical efficacy of different drugs combined with Chinese medicine line therapy,records of patients before and after treatment of closed fistula and the general condition.3.Patients with the inclusion criteria of Crohn’s disease during anal fistula remission were randomly divided into sidetransplant mucosal flap retention sphincter repair and mucosal flap sidesway repair,and evaluate the clinical efficacy of the two operations and anal function changes before and after surgery.Results:1.The modified Van Assche score showed a better correlation than Van Assche score and disease activity index CDAI,PDAI.And there are correlations with the patient’s blood biological indicators leukocytes,neutrophils,hemoglobin,hematocrit,platelets,C-reactive protein,erythrocyte sedimentation rate,albumin.The differences in modified Van Assche scores showed statistical significance in the CDAI ≥ 150 group and the CDAI<150 group.2.Different drugs combined with Chinese medicine thread therapy in active Crohn disease patients with anal fistula,anti-TNF-a monoclonal antibody therapy with Chinese medicine line therapy and azathioprine with Chinese medicine line therapy in the general condition and perianal With the improvement of the local conditions,better results have been obtained,which is better than the Mesalazine group.3.Lateral shift mucosal flap retention sphincter surgery to treat remission of Crohn’s disease anal fistula,curative effect and valvular prosthesis repair was no significant difference,and postoperative anal function and anal resting pressure were statistically significant.Conclusion:This study was to explore the application of conservative sphincter preservation in different stages of Crohn’s disease.The improved Van Assche MRI before operation was used to evaluate the activity and duration of Crohn’s disease,The use of drugs combined with Chinese medicine thread therapy for active Crohn’s disease anal fistula,mitral mucosal flap retention sphincter preservation surgery can be used as one of the recommended surgical methods. |
