AIM: To evaluate the efficacy of infliximab in the maintenance of Perianal fstulizing Crohn's disease. METHODS: The clinical data of 24 patients with perianal fistula Crohn's disease (PFCD) treated with infliximab (IFX) in the Department of Anorectal Surgery of our hospital from November 2020 to October 2023 were retrospectively collected. The clinical efficacy and safety were evaluated by observing the clinical characteristics for 54 weeks. The fistula remission rate, clinical remission rate, and endoscopic remission rate of patients were calculated. The changes of laboratory indexes before and after treatment were recorded. Logistic regression was used to analyze the related factors of fistula remission. All adverse reactions occurred during IFX treatment were recorded. RESULTS: After 54 weeks of IFX treatment, the fistula remission rate, clinical remission rate, and endoscopic remission rate were 37.5%, 45.83%, and 33.33%, respectively. Fistula response at 14 weeks of treatment (OR=19.419, 95%Cl: 1.267-297.559, P=0.033) was predictive factors for fistula remission at 54 weeks of treatment. The inflammatory indexes and nutritional indexes were significantly improved compared with those before treatment (P<0.01). The scores of PDAI, CDAI and SES-CD were significantly different from those before treatment (P<0.01). Five patients (20.83%) had adverse reactions, and the symptoms disappeared or improved after symptomatic treatment, and no patient had serious adverse reactions. CONCLUSION: IFX can effectively promote the closure of PFCD fistula, improve the chronic inflammatory reaction of intestinal mucosa, alleviate clinical symptoms, and improve the quality of life of patients. IFX is effective and safe for PFCD maintenance treatment.