克罗恩病并发症外科治疗的基本原则及目标

Basic principles and goals of surgical treatment for complications of Crohn＇s disease

克罗恩病在我国已逐渐成为常见病，需要手术治疗的患者越来越多，但由于需要手术治疗的患者常存在全身状况差、手术并发症风险因素多等原因，手术质量难以保证。本研究通过回顾国内外相关文献，提出克罗恩病外科治疗的主要目的是挽救生命，缓解临床症状；治疗目标是提高患者生命质量，延缓复发。笔者结合自己的临床经验，探讨了手术并发症的常见风险因素，包括营养不良，合并感染，术前使用免疫抑制剂等；提出了克罗恩病外科治疗应遵循的基本原则；尤其强调了医患双方充分的心理准备、纠正营养不良和营养风险、控制合并感染等措施在术前准备中的重要作用；明确了克罗恩病外科治疗的具体方法，强调遵循简单、微创、节约肠管的基本原则，主张通过建立临床路径提高外科治疗的效果。

Crohn＇ s disease （ CD ） has gradually become a common disease in China, more and more patients need surgical treatment. But the result of operation varied, as the surgical outcome is hampered by the poor general condition of the patients and risk factors of postoperative complications. The present review has summerized the objectives and goals of surgical treatment of CD, including saving lives, relieving clinical symptoms, improving the quality of life and postponing recurrence. Based on the clinical experiences of author, the common risk factors of postoperative complications were also listed, including malnutrition, complicating infection and preoperative immunosuppressive therapy. Basic principles of surgical treatment for CD mainly consist of psycological preparation of the patients and surgeons, correcting malnutrition and nutrition risks, controlling infection and other measures. Meanwhile, the rules of surgery should be simplistic, minimally traumatic and gut-saving, and clinical pathways should be followed to improve the surgical outcomes.