外科治疗克罗恩病合并肠穿孔25例的临床特征解析

Clinical characteristics of surgery for Crohn's disease complicated with intestinal perforation:a report of 25 cases

目的总结分析克罗恩病(Crohn′s disease,CD)合并肠穿孔的临床特征以及探讨外科治疗的具体疗效。方法纳入从2000年1月至2022年10月于华中科技大学同济医学院附属协和医院就诊的CD合并肠穿孔病人25例,对其进行回顾性分析,总结回顾病人的临床特征、手术治疗情况以及临床随访资料。结果25例合并肠穿孔的CD病人以男性多见(84%),确诊年龄多处于17~40岁之间(80%),穿孔部位以回肠多见(72%),病变性质主要为穿透性病变(80%)。所有病人均采取手术治疗,手术方案以腹腔镜辅助下肠切除为主(52%),多行肠造口(72%);术后并发症发生率为28%,其中主要以感染性疾病为主。术前术后病人均易发生贫血以及低蛋白血症。至随访截止日期为止,共12例复发(48%),1例死亡。结论CD合并肠穿孔以男性多见,穿孔多发生在回肠,入院后均行急诊手术。及时明确病因,注重围手术期管理,合理选择手术方式,可以减少CD合并肠穿孔病人术后并发症发生率及复发率。

Objective This study was intended to summarize the clinical characteristics of Crohn's disease(CD)complicated with intestinal perforation and explore the efficacy of surgery.Methods From January 2000 to October 2022,25 cases of CD complicated with intestinal perforation at Affiliated Union Hospital were retrospectively reviewed.Clinical characteristics,surgical approaches and clinical follow-up data were summarized.Results Among them,males dominated(84%)with a diagnostic age of 17 to 40 years(80%).The major site of perforation was ileum(72%)and nature of lesions largely transmural(80%).Surgical approaches included laparoscopic-assisted bowel resection(52%)and multiple ileostomies(76.9%).The postoperative complication rate was 28%and infections dominated.Both preoperative and postoperative patients were prone to anemia and hypoproteinemia.During follow-ups,there were recurrence(n=12,48%)and death(n=1).Conclusion CD complicated with intestinal perforation is more common in males and perforation occurs predominantly in ileum.Emergency surgery is recommended for all patients upon admission.Timely identification of etiology,optimal perioperative management and appropriate selection of surgical procedures may lower the incidence of postoperative complications and recurrence.