白塞病及其消化道病变的外科处理

Behcet's disease and its alimentary canal pathological changes by surgical treatment

目的 总结白塞病及其消化道病变的临床特征和外科治疗时机。方法 对 19例白塞病和有消化道病变病例的临床资料进行回顾性分析。对无外科并发症的病例按内科常规治疗 ,回肠穿孔 1例行小肠部分切除术后转ICU治疗 ;结肠白塞病并慢性阑尾炎 1例行阑尾切除术 ,因患者合并白血病术后转血液科 ;结肠白塞病无外科并发症 1例确诊后转皮肤科治疗。结果 白塞病确诊病例 19例 ,除转ICU治疗的 1例 2d后自动出院外 ,其余 18例均得到治愈或缓解 ,无死亡病例 ,其中 15例 ( 88.2 4% )得到随访 ,随访时间 1个月～ 4年 ,死亡 2例 (合并白血病死亡 1例 ,肺部感染致多器官功能衰竭死亡 1例 ) ,其余 13例中白塞病症状复发 12例 ( 92 .3 1% ) ,无外科并发症发生。结论 白塞病内科治疗有效 ,但病情多反复发作 ,消化道病变少见 ,临床表现多样且不典型 ,发生穿孔者病情严重 ,临床应予重视 ,适时采取手术治疗。表 1 3例消化道白塞病临床资料性别年龄 (岁 )临床特点最后诊断处理例 1女 47确诊BD1个月①白塞病小肠部分切除突然全腹剧痛②回肠穿孔例 2男 65确诊BD5年 ,头昏、乏力 3个月 ,右下腹疼痛①骨髓增生异常综合征②急性非淋巴细胞性白血病③白塞病④慢性阑尾炎阑尾切除术例 3女 38确诊BD4年 ,反复右中下腹疼痛半年 结肠白?

Objective To summarize the Behcet's disease,its clinical characteristics of the alimentary canal pathological changes and the opportune moment of the surgical treatment.Methods The clinical data of 19 cases of Behcet's disease with pathological changes of alimentary canal from May 1999 to May 2003 were retrospectively analyzed.The cases without surgical complications were treated by physician;There were three cases of pathological changes of alimentary canal (15.79 %):One case of the ileum perforation was turned to ICU after the partial enterectomy;One case of colon Behcet's disease associated with chronic appendicitis was subjected to appendectomy and turned to the department of hematology after the operation due to leukemia.One case of colon Behcet's disease without surgical complications was turned to the dermatology section.Results 19 cases of Behcet's disease were certainly diagnosed.Except that a patient treated at ICU get out of the hospital in 2 days,the rest of 18 cases all were cured or alleviated.There was no death.15 cases (88.24 %) were followed up for 1 month to 4 years.Two patients were died (One of them died of leukemia and one died of the several organs function that was caused by the infection of lung).Of the remaining 13 cases,recurrence of Behcet's disease occurred in 12 cases (92.31 %) and no surgical complications were noted.Conclusion The medical treatment is effective for Behcet's disease,but recurrence develops easily.The alimentary canal pathological changes of Behcet's disease were rare and the clinical characteristics were not typical.The diseased condition in the cases of perforation was severe and appropriate surgical treatments were necessary.