18例克罗恩病并发肠管膀胱瘘的诊疗分析

Diagnosis and treatment of 18 patients with Crohn's disease complicated with enterovesical fistula

目的克罗恩病并发肠管膀胱瘘尚无统一的诊疗规范。文中总结分析克罗恩病并发肠管膀胱瘘的临床特点及诊疗策略。方法回顾性分析2008年1月至2011年1月南京军区南京总医院普通外科收治的18例克罗恩病并发肠管膀胱瘘的患者资料,分析其临床特点、诊治方法及治疗效果。结果克罗恩病并发膀胱内瘘的症状以气尿(83.33%)、粪尿(61.11%)和尿路感染(66.67%)为主。其治疗以手术治疗为主,其中一期单纯行病变肠管切除吻合8例(44.44%),一期病变肠管切除吻合+膀胱修补3例(16.67%),单纯行肠造口6例(33.33%),1例末端回肠-直肠-膀胱瘘,行末端回肠造口、膀胱修补,同时修补直肠。所有患者均留置导尿管至膀胱瘘症状消失且影像学证实瘘口闭合,平均留置时间为2周。随访2年,除6例于肠造口3个月时行肠造口还纳术外,所有患者随访期间均未再出现肠管膀胱瘘、吻合口瘘。结论气尿、粪尿是克罗恩病并发肠管膀胱瘘的主要症状,CT检查及经导尿管泛影葡胺膀胱造影是简单、有效的诊断方法,病变肠管切除、留置导尿管或行膀胱修补是有效的治疗方法。

Objective There is still no diagnostic and treatment guideline for Crohn＇s disease complicated with enterovesical fistula. The aim of this study was to summary and analyze the clinical characteristics and strategies of diagnosis and treatment about Crohn＇s disease complicated with enterovesical fistula. Methods Eighteen patients with Crohn＇s disease （CD） complicated with enterovesical fistula （EVF） were reviewed, and the clinical characteristics and strategies of diagnosis and treatment, and therapeutic outcome were analyzed. Results The clinical symptoms were mainly pneumaturia （83.33%）, fecaluria （61.11%） and urinary tract infection （66.67%）. The treatments were mainly surgical treatment, including eight （44.44%） definite lesion resection with anastomosis, three （ 16.67% ） definite lesion resection and anastomosis together with bladder repair, six （33.33 % ） with enterostomy, only one with ileostomy and repair of bladder and rectum. All patients detained urethral catheter until the symptoms of EVF disappeared and radiologically confined fistula closure, and the average time of detaining urethral catheter was two weeks. All patients were followed up for at least two years. Six patients who had enterostomy performed stoma reversal surgery after three months, no patients had recur- rence of EVF. Conclusion Pneumaturia and fecaluria were the main symptoms of CD with EVF, computed tomography （CT） and urografin cystography via urethral catheter were the simple and effective methods for diagnosis. Lesion resection, detaining of urethral catheter or repair of bladder were effective treatments.