直肠瘘管型克罗恩病的诊断要点和处理难点  

Diagnosis and management of rectal fistulizing Crohn′s disease

作　　者：段明 李毅 Duan Ming;Li Yi(Department of General Surgery,Jinling Hospital,Medical School of Nanjing University,Nanjing 210002,China)

机构地区：[1]南京大学医学院附属金陵医院(东部战区总医院)普通外科,南京210002

出　　处：《中华炎性肠病杂志（中英文）》2023年第3期214-219,共6页Chinese Journal of Inflammatory Bowel Diseases

基　　金：国家自然科学基金(82270543)。

摘　　要：直肠瘘管型克罗恩病(CD)主要包括小肠直肠瘘、直肠膀胱瘘和直肠阴道瘘,具有手术操作复杂和终身性造口风险大等特点,是CD治疗中的巨大挑战。药物治疗的瘘管愈合率难以令人满意,但药物可诱导并维持CD缓解,为确定性手术的成功创造条件。针对具有明显肠瘘症状的CD患者,手术成为主要的解决方案。准确把握手术时机有利于控制疾病进展,降低近远期并发症风险。手术以切除疾病的原发部位为主,受累的肠壁、膀胱壁及阴道壁视情况予以相应的处理。本文将从流行病学、临床表现、治疗方法及笔者的临床体会等方面对直肠瘘管型CD进行阐述。Rectal fistulizing Crohn′s disease(CD)mainly includes rectoenteric fistula,rectovesical fistula and rectovaginal fistula.It is characterized by complex surgical procedures and high risk of lifelong colostomy,and is a huge challenge in the treatment of CD.The fistula healing rate of drug treatment is not satisfactory,but drugs can induce the remission and maintenance of CD,and create conditions for the success of definitive surgery.Surgery is the main solution for CD patients with obvious symptoms of intestinal fistula.Accurate timing of surgery can help control disease progression and reduce the risk of short⁃and long⁃term complications.The main surgical procedure is to remove the primary site of the disease,and the affected intestinal,bladder and vaginal walls should be treated depending on the situation.This article will describe the rectal fistulizing CD from the aspects of epidemiology,clinical manifestations,treatment methods,and the author′s clinical experience.

关 键 词：克罗恩病 直肠瘘管 小肠直肠瘘 直肠膀胱瘘 直肠阴道瘘 黏膜推进皮瓣 

分 类 号：R657.1[医药卫生—外科学]