克罗恩病的诊断与外科治疗

目的:探讨克罗恩病(CD)临床表现的多样性及其诊断与外科治疗。方法:回顾性分析了近5年以来收治的15例克罗恩病患者的临床资料。结果:15例患者中,男女比1.5∶1,平均年龄40岁,平均病程3.5年。腹痛(73.3%)、腹泻(40%)为本组住院CD为最常见的胃肠道表现,另外便血和腹部包块各占26.6%和20%。全身表现为贫血(46.6%)、消瘦(33.3%)及发热(33.3%)为主。病变常累及回盲部(53.3%)和回肠末端(40%)。结肠镜检查病变呈节段性分布,深而大的溃疡多呈纵形或铺路石样表现并有不同重度的狭窄者占58.3%,经过活检非干酪性肉芽肿者为41%。术后病检诊断率86.6%,内镜诊断率33.3%及X线胃肠道造影诊断率6.6%。本组病例中46.6%的患者因肠梗阻行手术治疗。结果:CD临床表现复杂多样,活检标本的诊断价值有限,误诊率较高,需结合病史、临床表现、辅助检查及病理分析综合考虑得以确诊。当本病并发肠梗阻、消化道大出血、肠穿孔、肠瘘、腹膜炎、腹腔脓肿等是外科治疗的适应证。对于病变局限于某一肠段,症状反复发作,且正规内科治疗效果不显著者宜外科手术治疗。

Diagnosis and Surgical Management of Crohn''''s Disease

Objective: To investigate the clinical manifestation,diagnosis and its surgical treatment of Crohn's Disease(CD).Methods: The clinic data of 15 cases collected during recent five years were retrospectively analyzed.Evaluation of the prevalence,clinical and pathological features,investigation process,diagnosis and treatment were made.Results: In 15 cases of CD,the ratio of male to female is 1.5∶1.The mean age and duration of CD at diagnosis is 40 years and 3.5 years respectively.The most common presenting gastrointestinal symptoms of CD were abdominal pain((73.3%)) and diarrhea(40%);blood stools(26.6%) and abdominal mass(20%) were also frequent.Anemia(46.6%),weight loss(33.3%) and fever(33.3%) were common systemic manifestations.The site most commonly involved were ileocolonic region(53.3%) and terminal ileum(40%).Colonoscopic features of CD were discontinuous involvement of inflammatory stricture,deep aphthoid-like ulcers or cobble stoning(58.3%),after biopsy presenting with non-caseating granulomas(41%).The diagnostic rate by post-operation pathology was 86.6%,by colonoscopy with biopsy was 33.3% and by radiological investigation barium enema was 6.6%.There were 46.6% patients due to intestinal obstruction undertook surgical therapy.Conclusion: Symptoms of CD are heterogeneous,the diagnostic biopsy rate is limited,and the misdiagnose rate is relatively high.A single gold standard for the diagnosis of CD is not available.The diagnosis is confirmed by clinical evaluation and a combination of endoscopic,histological,radiological,and/or biochemical investigations.Indications for surgery in CD are recurrent intestinal obstruction, GI bleeding,perforation,intestinal fistula,malignant change and fulminant colitis.Failure of medical therapy and recurrent attack should also be treated with surgery.