马应龙麝香痔疮膏联合柳氮磺吡啶栓治疗轻中度溃疡性直肠炎的临床观察

目的探讨马应龙麝香痔疮膏联合柳氮磺吡啶栓治疗溃疡性直肠炎的临床疗效和安全性。方法选择213例符合轻、中度溃疡性直肠炎诊断的患者随机分为马应龙麝香痔疮膏联合柳氮磺吡啶栓组(治疗组)108例,柳氮磺吡啶栓组(对照组)105例,疗程均为4周。对两组治疗前后的症状、电子结肠镜检查及不良反应进行比较。结果治疗组症状改善有效率均高于对照组,两组无不良反应发生。结论马应龙麝香痔疮膏联合柳氮磺吡啶栓治疗轻、中度溃疡性直肠炎安全有效。     

肛周克罗恩病18例临床分析

目的探讨肛周克罗恩病的临床特点、诊断及治疗方法。方法回顾性分析中国医科大学附属第四医院肛肠外科2012年1月至2014年12月期间收治的18例肛周克罗恩病患者的临床资料。结果所有病例均行手术治疗,术后给予抗炎、抑酸、坐浴熏洗等对症支持治疗,痊愈12例,6例中有2例在术后半年复发、4例在术后1年复发;痊愈患者术后随访1年未见复发。结论肛周克罗恩病临床表现无明显特异性,容易误诊延误病情治疗,诊断该病主要依靠细致的病史采集、临床表现、以及完善的影像学检查,治疗方法以手术治疗为主,早期诊断,早期治疗,避免误诊,是治愈肛周克罗恩病,降低复发率的重要措施。     

一次性根治克罗恩病致肛周脓肿1例报告

克罗恩病并发肛周病变者甚少,特别当肛周病变作为克罗恩病最初临床表现,而肠道症状缺乏或不典型,常被误诊为一般的肛瘘、肛裂、肛旁脓肿等.肠道克罗恩病的发病部位明显影响肛周病变的发生,回肠克罗恩病伴有肛周病变的发生率为 6%～27%,回结肠为8%～53%,结肠为46%～68%,当直肠被侵犯时,发生率是62.5%～100% [1].我科2007年收治1例肛周克罗恩病患者,现对其临床表现、诊断和治疗进行分析,以提高对本病的诊治水平.     

中西医结合治疗肛周克罗恩病17例

目的:探讨中西医结合治疗肛周克罗恩病的疗效。方法:回顾性分析17例肛周克罗恩病患者的临床资料,观察手术、挂线结合中药坐浴或口服治疗效果,采用肛周克罗恩病活动指数评价疗效,Wexner肛门失禁评分评价肛门功能,治疗前评分(9.59±0.45),治疗后评分(2.88±0.61)。结果:本组17例中临床缓解11例,有效6例;治疗后肛周克罗恩病活动指数中肛周分泌物、疼痛和活动受限情况、肛周病变、硬结情况均明显改善。结论:肛周克罗恩病治疗目的是缓解症状,保护肛门功能,中西医结合治疗疗效较好。     

肛周瘘管型克罗恩病处理原则北大核心CSCD

在克罗恩病病人中肛周瘘管型疾病十分常见,其中23%为复杂性肛瘘或多发性瘘管。肛周瘘管型克罗恩病在肛周克罗恩病的治疗中最为棘手,对肛周瘘管型克罗恩病的处理原则是依据局部病变特征,及时诊断,避免误诊误治。多学科协作、全面细致地评估后,通常先行手术引流感染灶治疗,随后应用药物治疗控制炎症,最后实施确定性手术闭合瘘管。     

肛周瘘管型克罗恩病处理原则

在克罗恩病病人中肛周瘘管型疾病十分常见,其中23%为复杂性肛瘘或多发性瘘管。肛周瘘管型克罗恩病在肛周克罗恩病的治疗中最为棘手,对肛周瘘管型克罗恩病的处理原则是依据局部病变特征,及时诊断,避免误诊误治。多学科协作、全面细致地评估后,通常先行手术引流感染灶治疗,随后应用药物治疗控制炎症,最后实施确定性手术闭合瘘管。     

盐酸小檗碱联合柳氮磺吡啶治疗溃疡性结肠炎的临床研究

目的:探讨盐酸小檗碱片联合柳氮磺吡啶治疗溃疡性结肠炎(UC)的临床疗效,以及对患者血清炎症因子及机体免疫功能的影响.方法:选择2019年1月至2020年12月我院收治的136例轻、中度UC患者为研究对象,随机分为对照组和观察组,各68例,对照组常规予以柳氮磺吡啶治疗,观察组在柳氮磺吡啶基础上予以盐酸小檗碱片治疗,治疗2...     

保留括约肌挂线法治疗克罗恩病肛瘘的临床疗效评价（附22例报道）

克罗恩病（Crohn disease）是以慢性肠道炎性病变为主要表现的全身性疾病,其肛周的局部病变越来越引起外科医师的关注,其中肛瘘的发生率可高达40％。笔者所在医院肛肠科白2009年7月至2012年11月期间应用保留括约肌挂线方法治疗22例克罗恩病并肛瘘患者,疗效较满意,报道如下。     

柳氮磺吡啶口服联合锡类散保留灌肠治疗溃疡性结肠炎的疗效探讨

为探讨柳氮磺吡啶口服联合锡类散保留灌肠治疗溃疡性结肠炎的临床疗效,将60例溃疡性结肠炎患者随机分为两组,各30例,一组采用柳氮磺吡啶口服联合锡类散保留灌肠治疗（治疗组）,一组单纯口服柳氮磺吡啶治疗（对照组）,比较两组疗效及治疗前后疾病活动指数（DAI）。结果显示,治疗组治愈27例,好转2例,无效1例,治愈率为90．0％;对照组治愈20例,好转6例,无效4例,治愈率为66．7％。治疗组治愈率明显高于对照组,P〈0．05。治疗后两组DAI均较治疗前显著降低,P〈0．05;治疗组降低更明显,P〈0．05。结果表明,柳氮磺吡啶口服联合锡类散保留灌肠能提高溃疡性结肠炎的临床治愈率。     

中药灌肠加柳氮磺吡啶栓治疗溃疡性结肠炎35例临床观察

为探寻更有效的治疗溃疡性结肠炎（UC）的方法,根据UC的病因、病机和中医辨证分型的原则,采用中药灌肠与柳氮磺吡啶栓直肠内给药相结合的方法治疗UC35例,并与对照组21例进行对比观察。结果显示,总有效率治疗组为94．3％,对照组为71．4％（P〈0．05）;复发率治疗组为20％,对照组为40％,治疗组明显优于对照组（P〈0．05）。结果表明,中药灌肠加柳氮磺吡啶栓直肠内给药治疗UC安全有效,副作用小,复发率低。     

Anovaginal and rectovaginal fistula in patients with Crohn's disease.

Between 1971 and 1991, details of 67 women with perianal Crohn's disease were recorded prospectively using the Cardiff classification. Two groups were identified according to the presence (n = 29) or absence (n = 38) of anorectal Crohn's fistula involving the vagina. Patients in both groups were of a similar age and had had Crohn's disease for a similar period before diagnosis of perianal involvement. The incidence of associated perianal lesions, superficial ulcers, cavitating ulcers, other fistulas and strictures was not significantly different between the two groups. A greater proportion of patients with anorectal-vaginal fistulation (n = 15) had distal intestinal Crohn's disease (rectal or contiguous colorectal) compared with women with no vaginal fistulation (n = 14). A range of therapies was used to manage women with perianal Crohn's disease, from local surgery to a defunctioning stoma and/or proctectomy. Only 13 of 38 women with perianal Crohn's disease but no vaginal fistula required a defunctioning stoma or proctectomy, whereas 18 of 29 with anorectal-vaginal fistulation underwent these procedures (P < 0.05). A vaginal fistula has a considerable adverse effect on the outcome of perianal Crohn's disease.     

Adenocarcinoma arising from chronic perianal Crohn's disease: case report and review of the literature

Perianal disease is a common manifestation of Crohn's disease. Rarely malignancy arises in perianal fistulas. The etiology of fistula related cancer remains a subject of debate. We present a unique case of a perianal Crohn's disease with adenomatous epithelialization of a fistula tract and an associated mucinous adenocarcinoma. Our case demonstrates that mucinous adenocarcinoma can arise in long standing perianal Crohn's disease and may be associated with adenomatous transformation of the epithelial lining of the fistula tract.     

Perianal Crohn's disease

BACKGROUND: The management of perianal Crohn's disease is difficult. A wide variety of treatment options exist although few are evidence based. METHODS: A search was conducted using the National Library of Medicine for articles on perianal Crohn's disease and its incidence, classification, assessment and management. RESULTS AND CONCLUSION: Perianal Crohn's disease can manifest as skin tags, ulcers, fissures, abscesses, fistulas or stenoses. Improved radiological imaging with endoanal anal ultrasonography and magnetic resonance imaging has improved its assessment and may be used to predict outcome after surgery. Many treatment options exist. During acute complications they are generally aimed at resolving the immediate problem and limiting damage to anal and perianal tissues; this may be a 'bridge' to definitive treatment. The likelihood of success of definitive treatment must be weighed against the risk of complications, especially faecal incontinence.     

皮肤切除术合苦参汤坐浴治疗慢性肛门湿疹的临床观察

目的观察肛周病变皮肤切除术配合苦参汤坐浴治疗慢性肛门湿疹的疗效。方法60例慢性肛门湿疹患者随机分为治疗组30例和对照组30例。治疗组采用肛周病变皮肤切除术配合苦参汤坐浴治疗;对照组采用复方曲安奈德益康唑乳膏（派瑞松）外涂,两组均以15d为1个疗程。结果治疗组治愈率及复发率分别为90．0％和13．3％;对照组有效率及复发率分别为73．3％和53．3％,两组比较,差异有统计学意义（P〈0．05）,治疗组明显优于对照组。结论肛周病变皮肤切除术配合苦参汤坐浴治疗慢性肛门湿疹疗效满意,值得临床推广。     

Surgical management of perianal lesions in Crohn's disease

Perianal lesions associated with Crohn's disease are often intractable and require surgical intervention. Among 28 patients surgically treated in our department, 16 patients manifested perianal complications consisted of four periproctal abscesses, eight anal fistulas, three skin tags and one anal fissure. The incidence of perianal lesions was higher in ileocolic type than in colic and ileal type. In half of our patients perianal lesions preceded the diagnosis of Crohn's disease, and they often gave the important clue for the diagnosis. The perianal lesions seemed to be independent of the activity of the intestinal lesions. The surgical treatments for the perianal lesions were performed on 13 patients and the results were satisfactory in most cases. But the results were very poor in four patients with rectal involvement. Two of them were obliged to undergo proctectomy because of the severely diseased anorectal lesions. Therefore radical surgery should be considered in patients whose perianal lesions are quiescent, and the severity of the rectal lesion was considered to be the major factor which decides the prognosis of the patients.     

克罗恩病外科治疗85例分析

目的总结分析肠道克罗恩病（CD）的外科治疗策略。方法对1980—2005年收治的85例CD病人资料进行回顾性分析。结果近年来CD病人呈增多趋势，术前确诊率为23．53％。肠梗阻（25．88％）、右下腹包块（回盲部肿物，10．59％）、盲肠癌（12．94％）、急性阑尾炎（4．71％）是术前误诊的几大主要原因。手术方式以右半结肠切除术（37．65％），小肠部分切除（21．18％）为主，内、外瘘及肛周CD行外科处理预后良好。结论手术仍是目前肠道CD的重要治疗手段；手术方式依病变部位和并发症类型不同而有差异，术式选择和规范化手术操作是亟待解决的问题。     

Effect of Fecal Diversion Alone on Perianal Crohn's Disease

The role of fecal diversion alone for perianal Crohn's disease remains unclear. This study was undertaken to assess its role in perianal Crohn's disease and to examine predictive factors for outcome. Thirty-one patients who underwent fecal diversion alone for perianal Crohn's disease between 1970 and 1997 were reviewed. The principal indications for fecal diversion were severe perianal sepsis in 13 patients, recurrent deep anal ulcer in 3, complex anorectal fistula in 9, and rectovaginal fistula in 6. Twenty-five patients (81%) went into early remission, and six (19%) failed to respond. Of the 25 early responders, 17 relapsed at a median duration of 23 months after fecal diversion. By contrast, 8 patients (26%) went into complete remission and required no further surgery at a median duration of 81 months after the diversion. Altogether, 22 patients required surgery at a median duration of 20 months after fecal diversion: proctectomy in 21 and repeated drainage of anal sepsis in 1. At present, intestinal continuity has been restored in only three patients (10%). The following parameters were compared in patients with and without complete remission after fecal diversion: age, gender, duration of disease, steroid use, smoking, coexisting Crohn's disease, preoperative blood indices, and Crohn's disease activity index. None of these parameters affected the outcome. In conclusion, fecal diversion alone is effective in selected patients with perianal disease, but the prospect of restoring intestinal continuity is low. There were no parameters to identify those in whom a successful outcome is likely.     

Anal carcinoma in patients with Crohn''s disease

Three patients with Crohn's disease and carcinoma of the anus are reported and compared to a group of patients with anal cancer and no inflammatory bowel disease. The three patients with Crohn's disease were relatively young women with significant perianal disease. There were two squamous cell lesions and one cloacogenic tumor in this group. The relative incidence of anal cancer as a proportion of all colorectal cancer, in patients with Crohn's disease (14%) was found to be significantly higher than the incidence of anal cancer in patients without inflammatory bowel disease (1.4%). Possible reasons for the increased incidence of anal cancer in Crohn's disease mentioned were: an overall increase in malignancies in inflammatory bowel disease, the high incidence of perianal disease, and the chronic long-standing perianal inflammation present. All patients with Crohn's disease, especially if they have active perianal disease, should be observed for the occurrence of anal cancer.     

Crohn's disease and its mucocutaneous involvement

Crohn's disease (CD) is a chronic inflammatory disorder primarily affecting the lower gastrointestinal tract but potentially involving the skin, musculoskeletal system, and eyes. The origin remains unknown, although diverse etiologic agents have been proposed. Characteristic pathologic appearances include the formation of "skip" lesions (discrete regions of inflamed bowel separated by uninvolved mucosae), aphthous ulceration, and fistulation; these signs relate to the presence of an underlying granulomatous transmural inflammation. Cutaneous and oral lesions frequently occur in CD. They may be classified as specific manifestations (in particular, perianal fissures, abscesses, sinuses, and fistulae in ano) with a granulomatous noncaseating inflammation on histologic examination, and nonspecific manifestations (eg, erythema nodosum, neutrophilic dermatoses) with a nonspecific histologic pattern. The diagnosis of CD is based on clinical, endoscopic, radiologic, and histopathologic features. Therapy is mainly aimed at the control of the acute disease and prevention of relapse through the use of mesalazine, corticosteroids, immunosuppressive agents and very recently, anti-tumor necrosis factor-alpha antibodies.     

Metastatic Crohn's disease

. Inflammatory bowel disease, especially Crohn's disease, demonstrates many extraintestinal manifestations. As a result, various dermatological lesions that have a different etiopathogenesis can be seen. In the case of metastatic Crohn's disease, extraintestinal granulomatous lesions may be observed in the orofacial and perianal regions, either accompanying bowel symptoms or as the first sign of disease. We report on a 30-year-old woman with sacral metastatic Crohn's disease who was initially treated with topical corticosteroid therapy and then underwent excision of the lesion followed by reconstruction utilizing bilateral advancement flaps.