克隆病的外科治疗  

Surgical treatment of Crohn＇s disease

作　　者：王远[1] 程西奎[1] 卢军[1] 钟朝辉[1] 杨燊[1] 黄迅[1] 

机构地区：[1]北京大学人民医院普外三科,100034

出　　处：《中国综合临床》2009年第4期418-421,共4页Clinical Medicine of China

摘　　要：目的探讨克隆病的外科治疗方式。方法对我院行外科手术治疗的克隆病11例的临床资料进行回顾性分析。结果本组患者术前确诊9例，主要症状为腹痛、腹泻或便秘、体重下降，病变多呈节段性分布。手术原因以腹部包块最多，占54．5％（6／11）；其次为肠梗阻，占36．4％（4／11）；肛周脓肿占9．1％（1／11）。手术方法主要为肠管部分切除吻合，有3例不除外恶变行右半结肠癌根治，其中2例术后病理为中度非典型增生。术后均恢复较好，与术前比较营养状态明显改善（P均〈0．05）。结论克隆病手术原因以腹部包块及出现肠梗阻为主，病程较长者有癌变倾向。手术方式以切除至无肉眼可见病变肠管较多，与扩大切除同样获得较好疗效。Objective To explore the surgical treatment of Crohn＇s disease （CD）. Methods Clinical data of 11 patients with Crohn＇s disease undergoing surgery were retrospectively analyzed. Results 9 cases were diagnosed before operation, with symptoms including abdomen pain, diarrhea or constipation, weight loss, and segmental lesions. Abdominal mass was the most common cause, accounting for 54.5 % （6/11 ） in surgery, and intestinal obstruction was secondary,accounting for 36.4% （ 4/11 ）, and perianal abscess, 9. 1% （ 1/11 ）. Partial entereetomy and anastomosis was the main procedure. 3 cases were suspected malignance and underging radical cure. The pathology results showed there was moderate atypical hyperplasia in 2 of 3. Most of the patients had a good recovery and their nutritional conditions were improved obviously （ P 〈 0.05 ）. Conclusion Abdominal mass and intestinal obstruction are the main causes of surgical management in patients with Crohn＇s disease. The possibility of cancerization is higher in patients with longer medical history. The length of intestine resected would be enough with visitable lesions resected, and the operative effects are as good as those underwent radical cure.

关 键 词：克隆病 外科治疗 手术 

分 类 号：R656.7[医药卫生—外科学]