外科手术对克罗恩病早期诊断延迟的影响及手术风险因素分析  

The effects of surgery treatment on the diagnostic delay of Crohns disease in early stage and analysis of risk factors associated with surgery

作　　者：曹慧[1] 司淑平[1] 王磊[1] 孙静[1] 许玉花[1] CAO Hui;SI Shuping;WANG Lei;SUN Jing;XU Yuhua(Department of Gastroenterology, Wuxi People＇s Hospital of Nanjing Medical University, Wuxi 214023, China)

机构地区：[1]南京医科大学附属无锡市人民医院消化内科,江苏无锡214023

出　　处：《实用医学杂志》2018年第8期1308-1312,共5页The Journal of Practical Medicine

摘　　要：目的探讨外科手术对克罗恩病(CD)早期诊断延迟的影响。方法通过对CD诊断前手术与非手术病例的比较,分析手术对早期诊断延迟的影响、手术率高的风险因素对早期诊断的价值。结果 215例CD患者中,男女比为1.7∶1,有合并症114例,其中诊前手术组75例,合并症未手术组39例,无合并症组101例,3组的发病年龄、确诊年龄有明显差异性(P<0.05),确诊时长无明显差异。并发症最常见为肛周病变(P,脓肿和/或瘘管)(49.1%)、肠梗阻(23.7%)、阑尾回盲部病变(12.3%);而诊前手术最常见原因为肛周病变(38.7%)、阑尾回盲部病变(17.3%),肠梗阻(16.0%),肠穿孔最易获得组织病理学确诊,肠外腹部手术10.5%。男性手术率高,而女性合并症及手术率低。3组病变均好发于回结肠(L3),而手术组单纯小肠型明显高于无合并症组及合并症未手术组(P<0.05),且疾病行为狭窄型(B2)+穿透型(B3)达60%,而合并症组炎症型(B1)+B2达87.2%,无合并症组B1达68.3%,且合并症组P占61.5%高于手术组44.0%,3组间均有显著性差异(P<0.001)。结论 CD早期行外科手术致诊断延迟是值得关注的。男性,年龄17～40岁,病变部位L3或小肠型、疾病行为B2和B3,是诊前手术的高风险因素;而女性,年龄17～40岁,有或无慢性合并症,更易获得早期诊断,手术风险小,预后相对好。肛周病变是CD早期的特征性表现,可以作为常规筛查的指标,其次是反复发作的肠梗阻。胃大部切除及胆囊术后的反复腹泻需警惕CD可能。Objective To explore the effects of surgery treatment on the diagnostic delay of Crohn＇s dis-ease（CD）in early stage. Methods The effects of surgical operation on diagnostic delay of early stage CD were an-alyzed,and the risk factors that in high surgical rate on early diagnosis were evaluated by comparing the surgicalcases with non-surgical cases before the diagnosis of CD. Results The ratio of male and female in the total 215 pa-tients with CD was 1.7 to 1. There were 114 cases with complications including 75 cases with surgery before diagno-sis,39 cases with non-surgical complications and 101 cases with no complications. The age of onset and age of di-agnosis in the three groups were significantly different（P〈0.05）,and there was no significant difference in thetime of diagnosis（P〈0.05）. The most common complications were perianal lesion（p,abscesses and/or fistula）（49.1%）,intestinal obstruction（23.7%）,and the diseases of appendix（12.3%）. The most common causes of pre-operative diagnosis were perianal lesion（38.7%）,the lesion of appendix（17.3%）,intestinal obstruction（16.0%）and the abdominal surgery（10.5%）whereas intestinal perforation is most easily recognized by histopathology. Therate of male surgery was high whereas the incidence of female complications was low. All three groups of lesionswere found to be in ileocolon（L3）in which the operation group with pure small intestine was significantly higherthan that in the group with no complications and in the group with non-surgical complications（P〈0.05）. Also theproportion of diseases behaving stricturing（B2）＋penetrating（B3）was 60%,but the complication group behavinginflammatory（ B1）＋B2 was 87.2%,the group with no complications behaving B1 reached 68.3%. and The compli-cation group behaving P was 61.5% which was higher than the operation group（44.0%）. There was a significant dif-ference between the three groups（P〈0.001）. Conclusions Diagnostic delay of CD on the early was signific

关 键 词：克罗恩病 外科手术 诊断 

分 类 号：R656.9[医药卫生—外科学]