克罗恩病合并瘘手术治疗24例  

Surgery therapy of Crohn disease complicated with fistula

作　　者：汪建平[1] 周军[1] 宋新明[1] 王磊[1] 黄美近[1] 吴小剑[1] 杨祖立[1] 兰平[1] 

机构地区：[1]中山大学附属第一医院结直肠肛门外科,广州510080

出　　处：《中华胃肠外科杂志》2006年第4期281-283,共3页Chinese Journal of Gastrointestinal Surgery

基　　金：国家自然科学基金(39970335);广东省自然科学基金(970055)

摘　　要：目的总结分析外科手术治疗克罗恩病(CD)合并痿的疗效和临床意义。方法对1980年1月至2005年4月期间收治的CD合并急性穿孔和瘘的手术病例进行回顾性分析。结果25年间确诊CD的181例中,合并瘘或穿孔病例24例(13．3%)。8例患者(33．3%)穿孔前明确使用过类固醇药物。9例无激素治疗史．其余7例情况不明。单一穿孔18例,2处游离穿孔4例,3处以上腹壁外瘘2例。急诊手术8例,择期手术16例；有20例在病变肠段切除的基础上,分别采取阴道或膀胱瘘口修补术4例,瘘管一期扩创切除12例,腹壁瘘管搔刮术4例；还有4例采取乙状结肠单腔造瘘加肛瘘切开术。术后5例患者(20．8%)出现并发症,其中切口感染2例,腹腔脓肿2例,吻合口瘘1例；均经外科引流、抗感染等保守措施治愈。死亡3例(12．5%),2例死于出血和持续高热；1例为感染合并多器官功能衰竭并造瘘口出血死亡。其余病例均痊愈出院。18例获6个月至18年的随访,5年瘘的复发率为16．7%。10年再手术率为33．3%。结论激素的应用并非构成CD合并瘘的主要因素,CD合并瘘应成为手术的明确指征。Objective To investigate the surgical treatment of Crohn disease（CD） complicated with perforation or fistula. Methods The clinical data of 24 CD cases complicated with perforation or fistula treated in our department from Jan. 1980 to Apr. 2005 were analyzed retrospectively. Results There were 24 eases d CD complicated with perforation or fistula among 181 CD patients, and the incidence of perforation or fistula was 13.3%. Steroid treatment before perforation was given in 8 patients, while not in 9 patients and unclear in 7 patients. Eighteen patients had single perforation, 4 patients two free perforations and 2 patients more than three exta-abdominal fistula. Emergency operation was performed in 8 cases and selective operation in 16 cases. Five cases had postoperative complications including incision infection in 2, intra-abdominal abscess in 2 and stomal fistula in one case, and were all cured by surgical drainage and anti-infection treatment. The morbidity rate was 20. 8%. The postoperative mortality rate was 12. 5% （3/24）. Eighteen patients were followed up from 6 months to 18 years, and the 5-year recurrent rate was 16.7%. The 10-year reoperation rate was 33. 3%. Conclusions Steroid use is not the main cause of perforation or fistula in CD. Perforation or fistula is the definite indication for surgical treatment.

关 键 词：克罗恩病 穿孔 瘘 外科治疗 

分 类 号：R656.9[医药卫生—外科学]