克罗恩病46例的外科治疗

目的探讨克罗恩病的特点及其有效的外科治疗方法。方法回顾性分析了近20年来收治的46例克罗恩病患者的临床资料。结果本组患者术前确诊16例,误诊率65.2%。病变呈节段性分布24例,弥漫性分布4例,单一分布18例,2例合并有癌变。手术治疗共62例次,手术原因以肠梗阻最多(44/62,71.0%)。手术方法以肠部分切除吻合术最多(38例次,61.3%),1990年前肠组织切除范围掌握在距离病变两端各10cm处;1990年后在保证吻合口通畅和足够血运的前提下,尽可能减少肠组织切除范围。随访发现,1990年前手术后的复发率为20.1%(3/13);1990年以后为25.0%(4/16);差异无显著性意义(P>0.05)。结论克罗恩病手术原因以肠梗阻最多见,切除肠管范围、切缘有无病变残留并不影响复发率。外科手术仅适用于治疗克罗恩病的并发症,不能改变其基本病变进程。

Surgical treatment of Crohn disease:report of 46 cases

Objective To elucidate the characteristics of Crohn disease and evaluate its surgical treatment.Methods Clinical data of 46cases with Crohn d isease during recent two decades were retrospectively analyzed.Results There were 24patients with segmenta l lesions,4with diffusive lesions and 18with single lesion.Canceriza tion was accompanied in 2patients.Only 16cases were diagnosed before operation,and the misdiagnosis ratio before operation was 65.2%.62operations were performed on these 46patients and intestinal obstructio n was the most common cause(44/62,71.0%).Partial enterectomy and anastomosis was the main procedure(38/62,61.3%).The recurrence rate was 20.1?fore 1990and25?ter 1990,and no significant di fference was found(P>0.05).Conclusions Intestinal obstruction is the most common cause of surgical management in patients with Crohn dis ease.The misdiagnosis ratio before operation was very high.The l ength of intestine resected or resid ual lesion are not related to the recurrence rate.Surgical procedur e is suitable only in dealing with com plications of Crohn disease,and can not change its essential progressio n.