因急腹症行急诊手术治疗克罗恩病26例临床分析

目的 探讨以急腹症为主要临床表现的克罗恩病(CD)的临床特点、诊断及外科治疗.方法 对1997年4月至2009年2月收治因急腹症行急诊手术且经病理证实为CD的患者26例进行回颐性分析.结果 17例表现为机械性肠梗阻,6例表现为腹膜炎,3例表现为消化道出血.术前诊断率仅为30.8%(8/26),术中诊断率为50.0%(13/26).行肠切除吻合术21例,行肠切除+造瘘术4例,行回肠末端切除+升结肠旷置术1例.2例围手术期死亡,其余24例均痊愈出院,其中1例因吻合口瘘于术后第5天行二次手术.结论 当CD伴有急腹症症状时,术前诊断尤为困难,应根据具体情况,及时采取适宜的手术治疗.

Analysis of clinical manifestations and emergency operations of Crohn disease:a report of 26 cases

Objective To discuss the clinical features,diagnosis and operative treatment in Crohn disease(CD)characterized by acute abdomen.Method The clinical data of 26 CD cases testified by pathology after emergency operations from April 1997 to February 2009 were retrospectively analyzed.Results In 26 cases of acute abdomen,17 cases characterized by mechanical obstruction,6 cases characterized by peritonitis,3 cases characterized by hemorrhage of digestive tract.Eight cases(30.8%)were diagnosed before operation,and 13 cases(50.0%)were diagnosed during operation,totally 80.8%(21/26).All patients received surgical operations as following:resection and anastomosis in 21 eases,resection and fistulation in 4 cases,ileotransverso-stomy in 1 case.Two cases died after operation,and others discharged including 1 case received second operation within 5 days.Conclusion It is difficult to be diagnosed before operation when CD characterized by acute abdomen,and appropriate emergency operations are needed according to the particular cases.