26例克罗恩病患者外科手术病例分析

目的 探讨克罗恩病的临床表现及外科治疗方法.方法 回顾性分析1997年8月至2010年8月外科治疗的26例克罗恩病患者的临床资料,随访时间1～13年.结果 术前确诊克罗恩病患者11例,误诊率57.7%.临床表现以肠梗阻为主占57.7%,其次消化道穿孔和消化道出血分别占26.9%和15.4%.以急腹症表现23例,占88.5%;全组均经手术治疗,其中小肠部分切除10例,回盲部切除4例,右半结肠切除7例,左半结肠切除4例,回肠结肠短路术1例.7例出现术后并发症,死亡1例.18例患者获得随访,随访率69.2%.16.7%(3/18)患者死亡,27.8%(5/18)患者明确复发,55.6%(10/18)患者无克罗恩病复发症状.结论 克罗恩病临床表现多样,外科手术病例多以肠梗阻、出血等急腹症为主,术式选择和规范化手术方式是治疗成功的关键.

Surgical treatment of 26 patients with Crohn's disease

Objective To investigate the clinical manifestations and surgical treatment of Crohn’s disease. Methods The clinical data of 26 patients with Crohn’s disease treated from August 1997 to August 2010 were analyzed retrospectively. The patients were followed up for 1 to 13 years. Results Eleven patients were diagnosed preoperatively and 15 (57.7%) were misdiagnosed before surgery. The main clinical manifestations of these patients included intestinal obstruction (57.7%), perforation (26.9%) and hemorrhage (15.4%). 23 patients (88.5%) presented with acute abdomen. All the patients underwent surgery, including 10 cases of partial enterectomy,4 cases of ileocolectomy, 7 cases of right hemicolectomy, 4 cases of left hemicolectomy and 1 cases of ileocolic anastomosis (bypass). There were 7 cases suffered complications and 1 cases of postoperative death. The morbidity and mortality were 26.9% and 3.8% respectively. In 18 patients (69.2%) followed up, 3 (16.7%) died during the period of follow-up, 5(27.8%) had recurrence of the disease, and 10 (55.6%) survived. Conclusions Most patients with Crohn’s disease may present with acute abdomen. It is difficult to make a correct diagnosis before operation when the disease is characterized by acute abdomen. Appropriate operative treatment is needed according to the clinical manifestations of the patients.