克罗恩病并发症的特点与治疗

Characteristics and treatment of the complications of Crohn＇s disease

目的 总结克罗恩病并发症的特点和治疗方法.方法 回顾性分析2000年1月至2007年12月南京军区南京总医院收治的202例合并并发症的克罗恩病患者的临床资料.其主要并发症为肠梗阻、肠瘘、急性肠穿孔、脓肿及腹腔包块等.结果 全组202例患者中有116例出现2次以上并发症,首次并发症为肠梗阻72例,肠瘘31例,急性肠穿孔23例,脓肿及腹腔包块各22例,肛周病变21例和消化道出血11例.再次并发症早期（≤3个月）以肠瘘（36例）为主;中晚期（＞3个月）以肠梗阻（24例）、肠瘘（22例）、脓肿（11例）多见.首次并发症202例患者中有170例行手术治疗,32例行非手术治疗.再次并发症116例患者中有96例行手术治疗,20例行非手术治疗.手术治愈127例,好转33例,死亡6例;非手术治疗患者症状好转,无死亡.结论 克罗恩病并发症以肠梗阻最多见,其次为肠瘘;手术是目前治疗克罗恩病并发症的重要方法.

Objective To investigate the characteristics and treatment of the complications of Crohn＇s disease. Methods The clinical data of 202 patients with Crohn＇s disease and relevant complications who were admitted to the Nanjing General Hospital of Nanjing Military Command from January 2000 to December 2007 were retrospectively analyzed. The main complications included intestinal obstruction, fistula, acute perforation, abscess, abdominal mass and et al. Results Of the 202 patients, 116 had more than two complications. Intestinal obstruction （72 patients） was the most common complication among the initial complications, and followed by fistula （ 31 patients）, acute perforation （ 23 patients ）, abscess （ 22 patients） , abdominal mass （ 22 patients ）, anal complications （21 patients） and gastrointestinal bleeding （11 patients）. Fistula was mostly observed in patients with secondary complications during the early stage （ ≤ three months ）, while obstruction （24 patients ）, fistula （22 patients） and obscess （11 patients） were prevalent during the mid-late stage （ 〉 three months）. Of the 202 patients with primary complications, 170 received surgical treatment and 32 received non-surgical treat- ment. Of the 116 patients with secondary complications, 96 received surgical treatment and 20 received non-surgical treatment. A total of 127 patients were cured by surgical treatment, the condition of 33 patients was improved and six patients died. The condition of patients received non-surgical treatment was improved, and no patient died. Conclusions The incidence of complications of Crohn＇s disease is increasing steadily. Intestinal obstruction is the most common complication, and then followed by fistula. Surgery is important in the treatment of the complications of Crohn＇s disease.