中国克罗恩病并发肠瘘诊治的专家共识意见

Chinese experts consensus on diagnosis and treatment of non-perianal fistulating Crohn disease

克罗恩病是累及消化道全层的慢性炎性疾病,肠瘘是其最为严重的外科并发症。治疗目标是治愈肠瘘与腹腔感染、恢复消化道的连续性、减少术后复发和改善生活质量。临床上应对克罗恩病并发的肠瘘进行充分评估,努力促进肠瘘的自行愈合,联合肠内营养与外科引流有助于促进肠瘘自行愈合。同时要重视围手术期营养状况的评估,并给予营养支持治疗。合并的腹腔脓肿建议使用Trocar穿刺置双套管建立主动冲洗引流。药物、营养治疗以及外科引流未能治愈的克罗恩病并发的肠外瘘与肠内瘘,需要考虑手术治疗,推荐腹腔镜手术应用于粘连较轻的克罗恩病并发的肠瘘。术后予以药物治疗并定期复查,尽可能减少克罗恩病术后复发以及肠瘘的再发。

Crohn disease (CD) is a chronic inflammatory disease involving the entire digestive tract and non-perianal fistula is the most serious surgical complication of CD. The goal of treatment is to cure intestinal fistula and intra-abdominal infection, restore the continuity of digestive tract, reduce postoperative recurrence, and improve the quality of life. Evaluation of nutritional status, especially during perioperative period, is important and nutrition support for malnutritional CD patients is necessary. Full assessment of non-perianal fistula and promotion of self-healing is the principal treatment, and surgical drainage combined with enteral nutrition may be a feasible treatment. Trocar puncture with sump drain is recommended to control intra-abdominal abscess. Surgical treatment of enterocutaneous fistula, enteroenteric fistula, enterovesical fistula or enterogynaecological fistula should be considered if medical treatment, nutrition support and surgical drainage fail.Laparoscopic surgery is recommended for patients with mild adhesion of non-perianal fistulating CD. Postoperative medical treatment and risk assessment should be carried out to reduce postoperative recurrence of CD and fistula.