以下消化道大出血为首发症状的克罗恩病8例临床分析

Crohn's disease presented first as lower digestive tract bleeding: report of eight cases

目的探讨以下消化道大出血为首发症状的克罗恩病(CD)患者的临床特点及诊治方法。方法回顾性分析2002年1月-2012年6月我院收治的以下消化道大出血为首发症状的8例CD患者的临床资料、临床特点及诊治情况。结果 8例患者发病前均无明确的CD的临床表现,出血量大,有5例出现失血性休克。其中病变在小肠的有5例(62.5%),在回结肠的有2例(25.0%),在结肠的有1例(12.5%)。3例行内科保守治疗,5例行外科手术治疗,行内科保守治疗的1例患者经抢救治疗无效死亡,其余患者治疗后好转。结论以下消化道大出血为首发症状的CD早期诊断有一定难度,内镜检查是发现出血部位和明确诊断的重要方法,大部分患者需手术治疗以控制出血,但如何预防反复出血仍需进一步的研究。

Objective To investigate the clinical features and the management of Crohn＇ s disease （CD） which presented first as bleeding of the lower digestive tract. Methods The clinical features and the outcomes of diagnosis and treatment of 8 patients with CD, whom were admitted to hospital from Jan. 2002 to Jun. 2012, were analyzed retro spectively. Results No definite manifestation related to CD was found before the onset in all 8 patients. After the on set, 5 patients suffered hemorrhagic shock. As to the lesion site, there were 5 patients （62.5%） in the small intestine, 2 patients （25.0%） in the ileocolon, and 1 patient （12.5%） in the colon. In 3 patients by expectant treatment, 1 pa tient died. Another 5 patients needed surgical intervention. Conclusion Early diagnosis of CD presented first as lower digestive tract bleeding is diffieuh. Endoscopy may be the key approach for determining the bleeding site and for clear diagnosis.~ A majority of patients need surgical operation to control bleeding, but the prevention of repeated bleeding is worth to be further studied.