结肠型克罗恩病的外科治疗效果分析

Effectiveness of surgical treatment on colonic Crohn’s disease

目的总结结肠型克罗恩病(CD)的特点和外科治疗价值。方法回顾性分析2009年2月至2017年1月期间四川大学华西医院收治的28例结肠型CD患者的临床资料。结果28例结肠型CD患者的术前确诊率为42.9%(12/28),误诊率为57.1%(16/28)。其中误诊为溃疡性结肠炎5例(17.9%),癌肿4例(14.3%),阑尾病变4例(14.3%),肠结核3例(10.7%)。28例患者中,行择期手术26例,急诊手术2例;手术方式以结肠部分切除术(10例)和右半结肠切除术(6例)为主;还联合回肠-结肠吻合术(9例)、结肠-结肠吻合术(6例)、小肠造瘘术(9例)、结肠造瘘术(6例)等。本组患者首次肠道病变相关手术的住院时间5~74 d(平均25.4 d),术后发生并发症9例(32.1%),发生并发症者均为未接受CD相关内科治疗的患者。术后获访20例,随访时间7~78个月(平均33.4个月),失访8例。随访病例的预后良好。结论结肠型CD的临床表现隐匿,容易误诊误治,结肠肠段切除手术是结肠型CD的重要治疗手段。对于有合并症的患者,多学科诊治很有必要。另外,术前系统的内科治疗有助于减少首次肠道病变相关手术的风险。

Objective To elucidate the characteristics of colonic Crohn’s disease(CD)and evaluate effectiveness of surgical treatment.Method Clinical data of 28 cases with colonic CD who underwent surgery at West China Hospital of Sichuan University between Feb.2009 and Jan.2017 were retrospectively analyzed.Results Definite diagnosis of colonic CD was performed in 12 cases preoperatively(42.9%),but 16 cases(57.1%)were misdiagnosed as other disease,ulcerative colitis(5 cases,17.9%),tumor(4 cases,14.3%),appendiceal disease(4 cases,14.3%),and intestinal tuberculosis(3 cases,10.7%)were the major causes of preoperative misdiagnosed disease.Of the 28 cases,elective surgery was performed in 26 cases and emergency surgery in 2 cases.The major surgical procedures were segmental colectomy(10 cases)and right hemicolectomy(6 cases),as well as ilecolostomy(9 cases),colocolostomy(6 cases),ileostomy(9 cases),colostomy(6 cases),and so on.The length of the first hospital stay of operation related to intestinal lesions in this group was 5–74 d(mean of 25.4 d).Postoperative complications were occurred in 9 cases(32.1%),all these cases didn’t receave medical treatment.Twenty cases were followed up,and the follow-up time was 7–78 months(mean of33.4 months),8 cases lost follow-up.The prognosis of the follow-up cases was good.Conclusions Colonic CD has occult clinical manifestation,resulting in misdiagnosis and mistreatment.Segmental resection of the colon is the important treatment for colonic CD.For patients with complications,multidisciplinary diagnosis and treatment is necessary.In addition,systematic medical treatment before surgery helps to reduce the risk of the first surgery associated with intestinal lesions.