炎症性肠病发生消化道狭窄的临床特点分析

目的探讨住院炎症性肠病(inflammatory bowel disease,IBD)患者发生消化道狭窄的临床特点。方法纳入2010年1月至2018年12月在中国人民解放军总医院第七医学中心住院诊治的IBD患者,对发生消化道狭窄患者的诊治过程和随访情况进行回顾性分析。结果发生消化道狭窄患者118例(23.14%),其中克罗恩病(Crohn’s disease,CD)、溃疡性结肠炎(ulcerative colitis,UC)和IBD类型待定(IBD unclassified,IBDU)的消化道狭窄发生率分别为59.02%、6.67%和34.25%,三者比较,差异有统计学意义(P<0.001)。病程0~10年的消化道狭窄发生率为25.06%,而病程>10年的发生率为14.29%,二者比较,差异有统计学意义(χ2=4.880,P=0.027)。发生消化道狭窄患者中,33.90%(40例)的患者经单纯药物治疗有效;55.93%(66例)的患者予以外科手术治疗,术后并发症发生率为18.46%(12例),10.61%(7例)的患者予以再次手术治疗。27.12%(32例)的患者予以内镜下治疗,内镜治疗有效率为81.25%(26例),18.75%(6例)的患者经内镜治疗无效后行外科手术治疗,内镜治疗术后并发症发生率为3.13%(1例)。结论消化道狭窄是IBD的严重并发症之一,CD的消化道狭窄发生率显著高于UC。有效的内科药物及营养治疗可降低消化道狭窄发生率、手术率。内镜治疗消化道狭窄具有较高的有效性、安全性,可有效避免外科手术的发生。

Analysis of clinical characteristics of digestive tract stenosis in inflammatory bowel disease

Objective To investigate the clinical characteristics of digestive tract stenosis in inflammatory bowel disease(IBD).Methods The patients with IBD who were admitted to the Seventh Medical Center,Chinese PLA General Hospital from Jan.2010 to Dec.2018 were included.The diagnosis,treatment and follow-up of digestive tract stenosis in IBD were analyzed,retrospectively.Results 118 patients(23.14%)had digestive tract stenosis,the incidence of CD,UC and IBDU were 59.02%,6.67%and 34.25%,respectively,there were statistically significant differences among them(P<0.001).In the disease course of 0-10 years,the incidence of digestive tract stenosis was 25.06%,while the incidence of digestive tract stenosis in the course>10 years was 14.29%,there was a statistically significant difference between the two groups(χ2=4.880,P=0.027).33.90%(40 cases)of the patients were effective with drug therapy alone.55.93%(66 cases)of the patients received surgical treatment,the postoperative complication rate was 18.46%(12 cases)and 10.61%(7 cases)received reoperation.27.12%(32 cases)of the patients received endoscopic treatment,the effective rate was 81.25%(26 cases),18.75%(6 cases)of the patients received surgical treatment after ineffective endoscopic treatment,and the postoperative complication rate was 3.13%(1 case).Conclusion Digestive tract stenosis is one of the serious complications of IBD,and the incidence of digestive tract stenosis in CD is significantly higher than UC.Effective internal medicine and nutrition treatment can reduce the incidence and surgery rate of digestive tract stenosis.Endoscopic treatment of digestive tract stenosis has higher effectiveness and safety,and can effectively avoid the occurrence of surgery.