克罗恩病合并肠梗阻的手术治疗  

Operation treatment of Crohn's disease with intestinal obstruction

作　　者：白雪[1] 闻巍[2] 于波[1] 苑树俊[1] 聂玉辉[1] 

机构地区：[1]北京军区总医院,北京100700 [2]解放军第309医院旃坛寺门诊部,北京100034

出　　处：《现代中西医结合杂志》2011年第36期4602-4603,4606,共3页Modern Journal of Integrated Traditional Chinese and Western Medicine

基　　金：国家自然科学青年基金资助项目(81000189)

摘　　要：目的探讨克罗恩病(CD)合并肠梗阻患者的鉴别诊断以及合理手术方式的选择。方法回顾性分析因肠梗阻手术治疗并最后确诊为CD的患者21例临床资料,观察其临床表现、梗阻部位及手术治疗转归。结果 21例患者均有不同程度的腹胀表现(100%);腹痛19例(90%);腹泻17例(81%);腹部肿块12例(57%),其中4例患者肿块有压痛2,例患者同时伴有反跳痛;并发反复发作的口腔溃疡1例,脾肿大1例,四肢关节疼痛1例。实验室检查:6例(28%)患者血红蛋白降低;21例(100%)血C反应蛋白升高;19例(90%)抗酿酒酵母抗体(ASCA)阳性。术前诊断完全性肠梗阻10例,不完全性肠梗阻11例。术中探查证实梗阻部位单独位于末端回肠8例,单独位于升结肠4例,末端回肠和升结肠均有不同程度梗阻的占9例。手术切除肠管距离肿块肉眼边缘约10 cm左右,均行吻合器吻合,术后无吻合口漏、狭窄等严重并发症。术后正规药物治疗,随访1～7 a,无再梗阻患者。结论 CD以内科治疗为主,但当出现完全性肠梗阻症状及反复发作难以治愈的不全梗阻时应积极手术治疗。手术尽量保留正常肠管,吻合口口径尽量足够宽敞,吻合器吻合并不增加手术并发症。Objective It is to approach the differential diagnosis and the reasonable operation modus of Crohn＇s disease with intestinal obstruction.Methods The clinical materials of 21 patients with intestinal obstruction by Crohn＇s disease were retrospective analysis.Results All patients（100%） with intestinal obstruction by Crohn＇s disease clinical manifested as abdominal distension,and abdominal pain 19 cases（90%）,diarrhea 17 cases（81%）,abdominal mass 12 cases（57%,included 4 cases with tenderness,and 2 case with rebound tenderness in which）;complicated by dental ulcer 1 case,splenomegalia 1 case,arthralgia 1 case.Laboratory examinations showed： anemia 6 cases（28%）,C-reactive protein step up 21 cases（100%）,anti-saccharomyces cerevisiae antibodies positive 19 cases（90%）.Preoperative diagnosis was complete intestinal obstruction 10 cases,incomplete intestinal obstruction 11 cases.Surgical exploration confirmed obstruction site at terminal ileum 8 cases,colon ascendens 4 cases,and both terminal ileum and colon ascendens 9 cases.All patients took enterectomy and inosculansed the intestinal canal with anastomat.No stomal leak or narrow post operation.Regularity medical treatment was complied after surgery treatment.Followed-up 1-7 years,there was no repeated obstruction patient.Conclusion Medical treatment is the main method of Crohn＇s disease.Surgical treatment should be adopt when complete intestinal obstruction or recurrent attacks persistance or progression of the critical symptoms and signs.As far as possible reserve intestinal canal during the operation,and as far as possible expand the stoma of the bowel.There is not increase the post operation complication when inosculansed the intestinal canal with anastomat.

关 键 词：克罗恩病 肠梗阻 手术 

分 类 号：R574.2[医药卫生—消化系统]