结肠克罗恩病58例外科处理分析

Analysis of surgical management of 58 patients with colonic Crohn's disease

目的 探讨结肠克罗恩病的外科处理方式及预后.方法 回顾性分析2014年5月至2017年4月浙江大学医学院附属邵逸夫医院58例结肠克罗恩病手术患者的临床和随访资料.结果58例患者中52例采取结肠节段切除术,6例采取结肠广泛切除术,其中腹腔镜手术40例,术后围手术期并发症15例.中位随访时间17.8个月,内镜复发22例,其中5例需再次手术.累及横结肠远端的结肠克罗恩病合并小肠病变少,手术时间及术后住院时间更长.结论 结肠克罗恩病的手术治疗应根据病变范围选择结肠节段切除手术或全结肠或全结直肠切除手术,术后密切随访复发情况.

Objective To explore the surgical treatment of colonic Crohn′s disease(CD).Methods To analyze retrospectively the clinical and follow-up data of 58 colonic CD patients who were admitted to Sir Run Run Shaw Hospitalfor surgery from May 2014 to April 2017.Results 52 patients received segmental colectomy,while 6 patients received subtotal or total colectomy.Laparoscopic operation was performed in 40 patients.Postoperative complication was found in 15 cases.During the follow-up of median 17.8 months,22 patients had endoscopic recurrence,of whom 5 cases underwent the secondary operation.CD patients with lesions located distal to transverse colon had less small bowel involvement,more rectal involvement,longer operative time and hospital stay.Conclusions Surgical procedures for Crohn's colitis include segmental colectomy,total colectomy or total coloproctectomy,according to the disease location.Patients should be closely followed up for recurrence.