克罗恩病合并回肠乙状结肠瘘的外科处理

Surgical treatment of ileosigmoid fistulas in Crohn＇s disease

目的探讨克罗恩病合并回肠乙状结肠内瘘的诊治方法。方法回顾性分析浙江大学医学院附属邵逸夫医院克罗恩病合并回肠乙状结肠内瘘13例患者的临床资料、诊断方法、手术方案及治疗结果。结果13例患者术前影像学检查确诊或疑诊回肠乙状结肠内瘘12例。13例患者均采取回肠末端或回盲部切除．其中乙状结肠瘘口采取修补术11例，部分切除术2例。11例患者采用临时性回肠造口，术后患者恢复良好，发生感染性并发症3例。结论克罗恩病合并回肠乙状结肠内瘘多数可以在术前确诊（或疑诊），治疗需要根据情况采取个体化的手术方案。

Objective To explore the diagnosis and surgical treatment of ileosigmoid fistulas （ISF） complicated by Crohn＇s disease （CD）. Methods 13 CD patients with ISF were collected. Patients＇ clinical data, diagnostic methods, surgical procedures and outcomes were reviewed. Results Suspected or definite diagnosis was suggested by preoperative imaging in 12 patients. All 13 patients received surgery. Ileal lesions were all removed, while sigmiod fistula were repaired in 11 patients and partially resected in 2 patients. 11 patients had a temporary ileostomy. All the patients recovered well, with 3 cases suffering from postoperative complications. Conclusions The diagnosis of ISF can be established preoperatively, and treatment should be individualized to patient＇ condition.