克罗恩病肛管直肠狭窄的诊断与治疗  

Diagnosis and treatment of Crohn′s disease⁃related anorectal stricture

作　　者：陈琪 乔立超 贡钰霞 竺平 杨柏霖 Chen Qi;Qiao Lichao;Gong Yuxia;Zhu Ping;Yang Bolin(Department of Colorectal Surgery,Affiliated Hospital of Nanjing University of Chinese Medicine,Nanjing 210029,China)

机构地区：[1]南京中医药大学附属医院肛肠科,南京210029

出　　处：《中华炎性肠病杂志（中英文）》2023年第3期220-226,共7页Chinese Journal of Inflammatory Bowel Diseases

基　　金：国家自然科学基金(82074431);江苏省中医院高峰人才项目(y2021rc27);江苏高校优势学科建设工程资助项目(035062005001);江苏省研究生实践创新计划(SJCX23⁃0867)。

摘　　要：克罗恩病(CD)相关的肛管直肠狭窄是发生在消化道远端的狭窄性病变,早期症状不明显,后期表现为排便困难、大便失禁和持续的肛门疼痛等,常需反复的内外科治疗,导致患者生活质量急剧下降。CD患者伴发肛管直肠狭窄通常预示着肠道炎症,尤其是直肠炎症未得到控制,显著增加转流性肠造口或直肠切除的风险。临床诊断需要综合详细的体格检查、内镜及活检、磁共振成像等。治疗以内科治疗为主,辅以内镜和器械扩肛,必要时外科手术干预,但目前缺乏标准化诊疗方案。本文对该病的发病机制、诊断及治疗方式进行阐述,以期对临床诊治有所帮助。Crohn′s disease(CD)⁃related anorectal stricture is a narrowing lesion that occurs in the distal part of the gastrointestinal tract.The symptoms of anorectal stricture in CD are not obvious in the early stage,but in the later stage,manifest difficulty in defecation,fecal incontinence,and persistent anal pain,often requiring repeated medical and surgical treatment,leading to a dramatic decrease in the patient′s quality of life.The presence of anorectal stricture in patients with CD usually indicates that the intestinal tract,especially rectal inflammation,is not controlled,and the probability of diverting stoma or rectal resection is significantly increased.Clinical diagnosis requires comprehensive detailed physical examination,endoscopy and biopsy,magnetic resonance imaging,etc.Treatment is based on medical therapy,supplemented by endoscopic and instrumental anal surgical intervention when necessary,but there is a lack of standardized treatment protocols.This article reviews the existing pathogenesis,diagnosis,and treatment modalities of this disease to help with clinical diagnosis and treatment.

关 键 词：克罗恩病 肛管直肠狭窄 诊断 治疗 

分 类 号：R657.1[医药卫生—外科学]