克罗恩病并发肠瘘综合治疗中的难点及对策  

Difficulties and strategies in the comprehensive management of Crohn's disease complicated by intestinal fistulas

作　　者：朱维铭 贡钰霞[1] ZHU Wei-ming;GONG Yu-xia(Inflammatory Bowel Disease Center,Department of Colorectal and Anal Surgery,Jiangsu Provincial Hospital of Chinese Medicine,Nanjing 210023,China)

机构地区：[1]江苏省中医院肛肠科炎症性肠病诊疗中心,江苏南京210023

出　　处：《中国实用外科杂志》2025年第3期266-269,273,共5页Chinese Journal of Practical Surgery

基　　金：国家自然科学基金面上项目(No.82170573);江苏省中医药科技发展计划重点项目(No.ZD202410)。

摘　　要：肠瘘是克罗恩病(CD)常见的并发症,能够引发腹腔感染、脓毒症、坏死性筋膜炎等急重症,治疗过程复杂且病死率较高。CD并发肠瘘的类型多样,临床上通常分为肠外瘘和肠内瘘两大类。CD并发肠瘘不仅具备普通肠瘘的病理生理特点,还常伴随肠道炎症、营养不良及治疗药物的副反应等多种不利因素,增加了临床治疗的难度。随着生物制剂等新型药物及技术的发展,CD并发肠瘘的非手术治疗方法逐渐增多,但手术依然是其主要治疗手段。采用内外科结合的综合治疗方案,充分进行病情评估和预康复,才能制定最优治疗方案,从而使病人最大化获益。Intestinal fistulas are a common complication of Crohn’s disease(CD)and can lead to severe conditions such as intra-abdominal infections,sepsis,and necrotizing fasciitis,with a complex treatment process and a high mortality rate.CD-related intestinal fistulas are of various types and are typically classified into two major categories,enteroenteric and enterocutaneous fistulas,in clinical practice.In addition to the general pathophysiological characteristics of intestinal fistulas,CD-related fistulas are often associated with intestinal inflammation,malnutrition,and the side effects of therapeutic drugs,which complicate clinical management.With the development of novel drugs such as biologics and other advanced technologies,non-surgical treatment options for CDrelated fistulas are emerging.However,surgical treatment remains the mainstay of therapy.A comprehensive treatment approach combining medical and surgical strategies,along with thorough disease assessment and prehabilitation,is essential to formulate the optimal treatment plan and maximize patient benefits.

关 键 词：克罗恩病 肠瘘 生物制剂 手术治疗 炎症 营养不良 预康复 肠内营养 

分 类 号：R6[医药卫生—外科学]