克罗恩病并发肠外瘘7例临床特征分析  

Clinical characteristics of 7 cases of Crohn’s disease complicated with external intestinal fistula

作　　者：贠建蔚[1] 金晶[1] 高峰鸿[1] 刘子燕[1] 黄晓俊[1] 王祥[1] 张德奎[1] YUN Jianwei;JIN Jing;GAO Fenghong;LIU Ziyan;HUANG Xiaojun;WANG Xiang;ZHANG Dekui(Department of Gastroenterology,the Second Hospital of Lanzhou University,Lanzhou 730030,China)

机构地区：[1]兰州大学第二医院消化科,甘肃兰州730030

出　　处：《胃肠病学和肝病学杂志》2021年第3期305-309,共5页Chinese Journal of Gastroenterology and Hepatology

摘　　要：目的分析克罗恩病(Crohn’s disease,CD)并发肠外瘘的临床特征。方法回顾性分析兰州大学第二医院2014年6月至2019年6月收治的7例CD并发肠外瘘患者的临床资料。结果7例患者的病史特点和诊疗经过有很多相似之处:7例中5例在起病初期因被怀疑为“急性阑尾炎”而在基层医院切除阑尾;7例累计发生肠外瘘11次,经类克、硫唑嘌呤、糖皮质激素等药物治愈3次,药物联合手术治疗治愈8次;病程最长的2例(14年和8年)在初次肠外瘘治愈后均有复发,且出现肛瘘、腰大肌脓肿等并发症;7例中4例直接胆红素(DBIL)水平轻度升高。结论应该充分重视肠镜检查在CD早期诊断过程中的价值,避免盲目切除阑尾;加强对CD患者的宣教和随访,通过规范治疗尽量避免可对患者造成严重危害的肠外瘘等并发症的发生甚至复发;重视CD并发肠外瘘患者药物和手术相结合的综合治疗。Objective To explore the clinical characteristics of Crohn’s disease(CD)complicated with external intestinal fistula.Methods The clinical data of 7 patients with CD,who were complicated by external intestinal fistula and admitted to the Second Hospital of Lanzhou University from Jun.2014 to Jun.2019,were analyzed retrospectively.Results The 7 CD patients had many similarities about the characteristics of medical history and the course of diagnosis and treatment.Firstly,5 of the 7 cases were suspected as“acute appendicitis”at the initial stage of onset,and appendectomies were performed in the primary hospitals;secondly,the 7 cases were complicated by intestinal fistula 11 times in total,3 times were cured by drugs such as ketamine,azathioprine and glucocorticoid,8 times were cured by drugs combined with surgery;thirdly,the two cases with the longer courses of 14 years and 8 years relapsed after the intestinal fistula was first cured,and other complications such as anal fistula and psoas abscess were observed;fourthly,the serum concentration of direct bilirubin(DBIL)in CD patients is slightly higher than the upper limit of the normal value in 4 of the 7 cases.Conclusion More attention should be paid to the value of colonoscopy in the early diagnosis of CD to avoid performing appendectomy blindly.It is very important to standardize the treatment and strengthen follow-up and education to prevent CD from external intestinal fistula even recrudescence of intestinal fistula,which could cause serious harm to the patient.Attention should be paid to the comprehensive treatment combined with drugs and surgery in patients with CD complicated with external intestinal fistula.

关 键 词：克罗恩病 肠外瘘 临床特征 直接胆红素 

分 类 号：R574.62[医药卫生—消化系统]