克罗恩病并发急腹症的风险分析与外科治疗

Risk factors and surgical treatment of Crohn disease complicated with acute abdomen

目的探讨克罗恩病(Crohn disease)引起急腹症的临床特点、外科治疗手段及预后情况。方法回顾性分析2005年至2011年间113例克罗恩病患者的临床资料,其中38例患者引起急腹症。将患者性别、年龄、病变部位和合并症及有无胃肠道外表现、病程长短作为分析资料。所有数据资料通过SPSS 19.0统计软件进行分析,采用Kaplan-Meier法计算克罗恩病患者引起急腹症的发病率及手术率。Fisher法检查用于发生率的对比。P<0.05差异有统计学意义。结果 113例克罗恩病患者中发生急腹症38例,总发病率33.6%,既往无慢性病史,首次发病即为急腹症者21例,发病率18.6%,在慢性病基础上急性发病者17例,发病率18.5%(17/92)。其中性别、年龄、病变部位作为急腹症发病率的独立预测因素。男性发病高于女性,发病年龄(32.1±13.8)岁,31~60岁年龄组发病高于其他组,结肠型及回结肠型患者发病高于回肠型患者(P<0.05)。有无肠外表现及是否合并有其他疾病等与急腹症发病无关(P>0.05)。33例(86.8%)患者采取手术治疗,恢复良好。结论克罗恩病有较高的急腹症发生率,发病年龄在31~60岁,病变位于结肠者较小肠型者发病率高,手术方式以外科手术为主。

Objective To evaluate the clinical characteristics and surgical treatment of acute disease in patients with Crohn disease . Methods Clinical datas of 38 cases of Crohn disease complicated with acute abdomen in 113 cases of Crohn disease from 2005 to 2011.The clinical factors of the patients that included gender, age, location,complications, whether or not with gastrointestinal outward manifestations and the Course of disease were analyzed and compared .All the datas were analyzed through SPSS 19.0, Kaplan-Meier was used to calculate the incidence and the initial operation of Crohn disease complicated acute abdomen, comparison of the incidence was tested by Fisher , P〈0.05 was determined to be significantly different. Result The incidence rate of Crohn disease complicated with acute abdomen was 33.6%, among the 38 patients, 21 cases（18.6%） had no history of chronic disease attack , and 17cases（18.5%） had chronic Crohn disease before .Among those factors , the gender , age and location were independent risk factors for prediction the incidenc , The male had a higher risk of complicated with acute abdomen than the famale, 31~60 years of age group had the high incidence at onset , the mean age was 32.1 ±13.8 years. The type of colonic and ileocolonic disease was significantly higher than the ileal （P〈0.05）.33 patients （86.8%） were treated with surgical intestinal resection , the recovery was satisfied. Conclusion In Crohn disease patients , it runs a higher risk to cause acute abdomen .It has a higher incidence of acute abdomen in Crohn disease involving colon than small bowel .Most acute abdomen in Crohn disease are treated with intestinal resection .