克罗恩病外科治疗19例

Surgical treatment of Crohn’s disease: an analysis of 19 cases

目的:探讨克罗恩病诊断、手术及术后维持治疗.方法:回顾性分析19例经手术、病理证实的克罗恩病患者的临床表现、术前检查及诊断、手术情况及诊断、术后并发症及维持治疗等临床资料.结果:克罗恩病误诊率高,术前明确诊断为克罗恩病的仅3例,误诊率为84.21%.临床表现不典型,临床表现以腹痛及消化系症状为主,19例均有不同程度腹痛,腹痛发生率为100%,症状与病变部位有关.本组病例急诊手术3例,择期手术16例,急诊手术占15.79%.其中4例患者为2次手术,占21.05%.术后切口感染2例,切口脂肪液化2例,术后死亡1例,术后并发症发生率26.32%.术后维持缓解12例,占63.16%.有效5例,占26.32%.复发1例,占5.26%.结论:克罗恩病有较高的误诊率,病程早期临床表现不典型是该病易误诊的主要原因之一,手术兼有治疗和明确诊断的双重意义.手术可解决相关并发症,改善患者的生活质量,术后恰当的药物维持治疗可望减少复发.

AIM： To investigate the diagnosis, surgical treatment and postoperative maintenance therapy of Crohn＇s disease. METHODS： The clinical data for 19 patients with surgically and pathologically proved Crohn’s disease was analyzed retrospectively, including clinical manifestations, preoperative examination and diagnosis, intraoperative performance and diagnosis, and postoperative complications and maintenance therapy. RESULTS： The rate of misdiagnosis of Crohn’ s disease was high. Only 3 patients were definitively diagnosed before operation, and the misdiagnosis rate was 84.21%. Crohn’ s disease showed atypical clinical manifestations. The symptoms of Crohn＇s disease were mainly abdominal pain and gastrointestinal tract symptoms. All patients had varying degrees of abdominal pain. Symptoms were related to diseased region. Emergency surgery was performed in 3 （15.79%） cases, and elective operation in 16 （84.21%） cases. Reoperation was performed in 4 （21.05%） patients. Postoperative incision infection occurred in 2 cases, fat liquefaction of incision in 2 cases, and death in 1 case. The rate of postoperative complications was 26.32%. Postoperative maintenance of remission appeared in 12 （63.16%） cases. Effective results were achieved in 5 （26.32%） cases. Recrudescence occurred in 1 （5.26%） case. CONCLUSION： The rate of misdiagnosis of Crohn’s disease is high, mainly due to atypical clinical manifestations in the early period of the disease. Surgery can lead not only to a cure for the disease but also to verification of diagnosis. Surgical treatment can solve associated complications and improve patient’s quality of life. Postoperative maintenance drug therapy can reduce recrudescence.