克罗恩病合并肠外瘘患者26例诊治分析

Analysis of diagnosis and treatment of 26 cases of crohn disease complicated with intestinal fistula

目的:分析克罗恩病合并肠外瘘的临床特点以及对不同治疗方法的疗效。方法:1990-2009年收治克罗恩病合并肠外瘘患者26例,观察患者的临床特点、治疗反应以及生物治疗在肠外瘘与肛瘘疗效之间的关系,应用Harvey-Bradshaw指数判定克罗恩病的活动指数。依据临床判断,确定为部分缓解或完全治愈。结果:在67%的患者中,抗肿瘤坏死因子治疗能够减少肠瘘漏出量,其在术后肠瘘中的疗效优于自发性肠瘘,有效率分别为80%、57%。手术治疗后,自发性肠瘘、术后肠瘘的治愈率分别为100%、60%。结论:尽管大多数患者最终需要手术治疗,但在一部分接受治疗的患者中,抗肿瘤坏死因子治疗能够减少肠瘘漏出量。因此,该方法可作为一些患者的术前治疗措施。

Objective:To analyze the clinical features of Crohn's disease complicated with intestinal fistula and the efficacy of different treatment.Methods:26 cases of Crohn's disease complicated with intestinal fistula were selected from 1990 to 2009.We observed the relationship between the clinical characteristics,treatment response and biological therapy in the treatment of intestinal fistula and fistula.We determined the Crohn's disease activity index with Harvey-Bradshaw index.On the basis of clinical judgment,patients were identified as partial remission or cure.Results:In 67% of the patients,anti-tumor necrosis factor therapy can reduce the intestinal leakage.Its effect was better than spontaneous fistula in the intestinal fistula.Efficiency was respectively 80% and 57%.After operation treatment,the cure rate of spontaneous fistula and intestinal fistula respectively was100% and 60%.Conclusion:Although most patients will eventually need operation treatment,but in some of the patients with treatment,anti-tumor necrosis factor therapy can reduce the leakage of intestinal fistula.Therefore,the method can be used in some patients before treatment.