| Background:Crohn’s disease(CD)is an unexplained inflammatory disease of the digestive tract that can occur anywhere in the gastrointestinal tract.As an anal manifestation of Crohn’s disease,anal fistula is still a serious clinical challenge due to its own development and potential pathological changes.A reasonable treatment plan should be combined with medical treatment based on surgical treatment.Infliximab(IFX)combined with suture placemen can significantly improve the clinical efficacy of CD anal fistula.This program is based on the premise of protecting the anal sphincter,maintaining the fistula unobstructed,ensuring adequate drainage and preventing premature closure of the external.However,there is still some controversy in this program,fistula often relapses after a few years of initial closure(even more than 5 years),the lack of long-term follow-up and small sample size are limitations of current research.Objective:To investigate the long-term efficacy of Infliximab combined with seton placemen in the treatment of anal fistula with Crohn’s disease,and to analyze the factors affecting clinical healing and recurrence.Methods:A prospective database retrospective study.CD patients who were diagnosed and treated by colorectal surgery at the Affiliated Hospital of Nanjing University of Traditional Chinese Medicine from July 2010 to January 2017 were collected.Inclusion of CD anal fistula with IFX combined with suture therapy and follow-up for more than 1 year.The healing and recurrence of CD with anal fistula were counted and their influencing factors were determined by univariate and multivariate analyses.The Kaplan-Meier survival curve was drawn to calculate the cumulative probability of fistula recurrence.Results:A total of 103 CD patients with anal fistula were included in the study.After a median follow-up of 36 months(IQR 23-58),39 patients had symptomatic relief,64 patients had fistula healing completely,and 47 patients had no recurrence,34 patients relapse.The cumulative probability of the recurrence of fistula in the first,third,and fifth years was 21.8%,32.6%,and 37.4%,respectively.Univariate analysis showed that long-term healing of fistula was significantly associated with Montreal classification B1(75%vs 25%,P=0.001),no abscess(53.1%vs 46.9%,P=0.013),no rectal inflammation(67.2%vs 32.8%,P=0.010)and no stenosis(75.0%vs 53.8%,P=0.021);the recurrence of fistula was significantly associated with the number of IFX maintenance(P=0.017).Multivariate analysis showed that Montreal classification B1(HR=3.987,95%CI,1.640-9.694,P=0.023)and no abscess(HR=2.724,95%CI,1.101-6.740,P=0.030)was positively associated with long-term healing of fistula,and IFX maintenance treatment>3 times(HR=5.497,95%CI,1.197-25.251,P=0.028)was a risk factor for recurrence.Conclusions:Approximately 2/3(62.1%)of patients with long-term healing with IFX in combination with seton placement.Montreal classification B1,without abscess,and IFX maintenance treatment≤3 times is expected to have a better long-term efficacy. |
