肠型白塞病并发急腹症的临床特点与外科治疗  

Clinical characteristics and surgical treatment of enteric Behcet disease complicated with acute abdomen

作　　者：周庆淼 王荣剑 何剑波 何宇 余育俊 王琛 韩少良[1] Zhou Qingmiao;Wang Rongjian;He Jianbo;He Yu;Yu Yujun;Wang Chen;Han Shaoliang(Department of Gastrointestinal Surgery,the First Affiliated Hospital of Wenzhou Medical University,Wenzhou 325000,China)

机构地区：[1]温州医科大学附属第一医院胃肠外科,浙江省325000

出　　处：《中华普通外科杂志》2020年第6期455-459,共5页Chinese Journal of General Surgery

基　　金：浙江省自然科学基金课题资助(Y15H160192)。

摘　　要：目的探讨肠型白塞病并发急腹症的临床特点及外科治疗方法。方法回顾性分析1997年12月至2017年6月在温州医科大学附属第一医院接受外科治疗的肠型白塞病并发急腹症9例患者的临床资料与随访结果。结果本组9例患者均有不同程度腹痛,其中伴随血便1例,伴排气及排便障碍1例。查体:触及腹部包块2例,腹膜炎体征5例,右下腹部压痛1例。肠穿孔、急性阑尾炎、回肠窦道、肠梗阻及消化道大出血是本组患者的手术原因。实施剖腹探查或腹腔镜探查,手术方式包括回盲部切除2例,小肠部分切除3例,腹腔镜下阑尾切除1例及右半结肠切除3例。术后发生切口感染1例,吻合口瘘1例,粘连性肠梗阻1例。对8例患者中位随访7.5年,发现白塞病复发4例,无肠型白塞病复发。结论肠穿孔、肠出血及肠梗阻是肠型白塞病并发急腹症的主要原因,急诊手术是其治疗的重要手段,同时进行营养支持和药物治疗是控制本病的根本措施。Objective To investigate the clinical characteristics and surgical treatment of enteric Behcet′s disease with acute abdomen.Methods The clinical data and follow-up results of 9 patients with enteric Behcet′s disease with acute abdomen treated surgically were analyzed retrospectively.Results All patients in this group had abdominal pain,with bloody stool in one case,failure to exhaust and defecation in 1 case.Physical examination revealed abdominal mass in 2 cases,peritonitis sign in 5 cases and tenderness of the right lower abdomen in 1 case.The causes of operation were pathological perforation of ileocecal region,pathological perforation of small intestine,acute appendicitis,ileum fistula,intestinal stenosis and obstruction and massive hemorrhage of lower digestive tract.In this group,laparotomy or laparoscopy were done in these cases,including ileocecal resection in 2 cases,partial resection of small intestine in 3 cases,laparoscopic appendectomy in 1 case and right colon colectomy in 3 cases.Incision infection occurred in 1 case,anastomotic leakage in 1 case and adhesive intestinal obstruction in 1 case occurred after operation.The median follow-up time of 8 cases was 7.5 years,and Behcet′s disease recurred in 4 cases,but no recurrence of enteric Behcet disease was found.Conclusions Intestinal perforation,bleeding and obstruction are the main causes of intestinal Behcet′s disease with acute abdomen,and emergency surgery is an important means of treatment,moreover,nutrition support and drug therapy are the important supportive therapy to control this disease.

关 键 词：贝赫切特综合征 急腹症 外科手术 

分 类 号：R597.9[医药卫生—内科学] R656.1[医药卫生—临床医学]