26例克罗恩病患者外科手术病例分析

Surgical treatment of 26 patients with Crohn’s disease

目的探讨克罗恩病的临床表现及外科治疗方法。方法回顾性分析1997年8月至2010年8月外科治疗的26例克罗恩病患者的临床资料,随访时间1～13年。结果术前确诊克罗恩病患者11例,误诊率57.7%。临床表现以肠梗阻为主占57.7%,其次消化道穿孔和消化道出血分别占26.9%和15.4%。以急腹症表现23例,占88.5%;全组均经手术治疗,其中小肠部分切除10例,回盲部切除4例,右半结肠切除7例,左半结肠切除4例,回肠结肠短路术1例。7例出现术后并发症,死亡1例。18例患者获得随访,随访率69.2%。16.7%(3/18)患者死亡,27.8%(5/18)患者明确复发,55.6%(10/18)患者无克罗恩病复发症状。结论克罗恩病临床表现多样,外科手术病例多以肠梗阻、出血等急腹症为主,术式选择和规范化手术方式是治疗成功的关键。

Objective To investigate the clinical manifestations and surgical treatment of Crohn＇ s disease. Methods The clinical data of 26 patients with Crohn＇ s disease treated from August 1997 to August 2010 were analyzed retrospectively. The patients were followed up for 1 to 13 years. Results Eleven patients were diagnosed preoperatively and 15 （57.7%） were misdiagnosed before surgery. The main clinical manifestations of these patients included intestinal obstruction （57.7%） , perforation （26.9%） and hemorrhage （15.4%）. 23 patients （88.5%） presented with acute abdomen. All the patients underwent surgery, including 10 cases of partial entereetomy ,4 cases of ileocoleetomy ,7 cases of right hemicolectomy, d cases of left hemicolectomy and 1 cases of ileocolic anastomosis （bypass）. There were 7 cases suffered complications and 1 cases of postoperative death. The morbidity and mortality were 26.9% and 3.8% respectively. In 18 patients （69.2%） followed up, 3 （ 16.7% ） died during the period of follow-up, 5 （27.8%） had recurrence of the disease, and 10 （55.6%） survived. Conclusions Most patients with Crohn＇ s disease may present with acute abdomen. It is difficult to make a correct diagnosis before operation when the disease is characterized by acute abdomen. Appropriate operative treatment is needed according to the clinical manifestations of the patients.