本文選題：克羅恩病 + 胃十二指腸�。� 參考：《浙江大學(xué)》2017年碩士論文

【摘要】：研究目的與背景:克羅恩病(Crohn's Disease,CD)是一種反復(fù)發(fā)作的,慢性非特異性腸道炎癥性病變?yōu)橹鞯娜硇约膊?其發(fā)病率逐年上升,但發(fā)病機(jī)制目前尚未明確。CD可累及全消化道,最常累及末端回腸,累及胃十二指腸的患者相對(duì)較少,本文旨在探究CD累及胃十二指腸的病變特點(diǎn)及外科治療方式;方法:回顧性收集2009年1月至2017年2月浙江大學(xué)醫(yī)學(xué)院附屬邵逸夫醫(yī)院炎癥性腸病中心治療過的確診為CD且累及胃十二指腸的患者。收集其一般資料,臨床表現(xiàn),患病時(shí)間,肛周病變史,既往腸道手術(shù)史,實(shí)驗(yàn)室指標(biāo)及影像學(xué)結(jié)果,內(nèi)科治療情況,手術(shù)方式;手術(shù)并發(fā)癥及復(fù)發(fā)情況;結(jié)果:共有21例患者納入研究(男16,女5),平均年齡為38.9±9.9(27～64)歲,中位發(fā)病年齡為31(18～50)歲,BMI 17.7±2.7(12.6～23.3)。1例患者有家族史(母親),2例患者有吸煙史。2例患者有腸外表現(xiàn)(口腔潰瘍)。CD胃十二指腸病變?cè)l(fā)的有15例,繼發(fā)于結(jié)腸或小腸的有6例。CD患病時(shí)間中位時(shí)間為8年(1月至22年),診斷CD累及胃十二指腸病變時(shí)間中位時(shí)間為2年7個(gè)月(1月至15年),首次診斷CD時(shí)就伴有胃十二指腸病變的有7例患者。12例患者有腸道手術(shù)病史,15例患者有肛周手術(shù)史。15例CD原發(fā)于胃十二指腸的患者,BMI12.6～23.3(18.1±3.1),貧血患者總共7/15例;6例CD累及胃十二指腸繼發(fā)于結(jié)腸或小腸的患者,BMI16.0～18.2(16.7±0.8),貧血患者總共6/6例。臨床表現(xiàn):14例患者發(fā)生胃出口梗阻,2例消化道穿孔,1例檢查發(fā)現(xiàn)結(jié)腸胃瘺,4例患者無胃十二指腸癥狀,術(shù)中才發(fā)現(xiàn)CD累及胃十二指腸。CD累及胃十二指腸的臨床類型中有14例患者是狹窄型,6例患者是穿透型,另有1例患者合并有狹窄型和穿透型。21例患者中1例為單純胃十二指腸CD,其余20例患者均有除了胃十二指腸外累及(食管2例,小腸19例,結(jié)腸12例,直腸肛管2例)。所有患者均采用藥物治療,其中4例患者行內(nèi)鏡下球囊擴(kuò)張術(shù)。11例手術(shù)治療的患者中共有5例患者因胃出口梗阻行手術(shù)治療,其中3例患者行幽門狹窄成形術(shù),1例患者行遠(yuǎn)端胃切除+BII式吻合術(shù),1例患者行胃部分切除術(shù)。2例行十二指腸修補(bǔ)術(shù)。4例患者因出現(xiàn)胃腸瘺行手術(shù)治療,其中2例患者行胃部分切除術(shù),2例患者行胃修補(bǔ)術(shù)。結(jié)論:CD累及胃十二指腸可表現(xiàn)為胃出口梗阻、消化道穿孔、內(nèi)瘺形成等。原發(fā)于胃及十二指腸的患者,英夫利昔單抗聯(lián)合腸內(nèi)營養(yǎng)支持及內(nèi)鏡擴(kuò)張等等可治療輕中度胃十二指腸狹窄型病變,內(nèi)科治療無效需要外科治療,手術(shù)方式可行狹窄成形術(shù),胃腸短路術(shù)或部分切除術(shù),避免出現(xiàn)急性消化道穿孔等并發(fā)癥。繼發(fā)于小腸或結(jié)腸的胃十二指腸CD患者,部分可通過影像學(xué)檢查發(fā)現(xiàn),部分于手術(shù)探查中發(fā)現(xiàn),可手術(shù)切除瘺管,行胃部分切除或十二指腸修補(bǔ)。
[Abstract]:Objective and background: Crohn's disease (Crohn's disease) is a recurrent, chronic, nonspecific inflammatory disease of the whole body. Its incidence is increasing year by year. However, the pathogenesis of Crohn's disease is not clear. The most frequently involved terminal ileum and gastroduodenal involvement were relatively few. The purpose of this study was to explore the characteristics and surgical treatment of CD involvement of gastroduodenum. Methods: from January 2009 to February 2017, the patients with CD and gastroduodenal involvement were collected from the Center for inflammatory Bowel Disease of run Shaw Hospital, Zhejiang University Medical College. General data, clinical manifestations, time of disease, history of perianal lesions, history of previous intestinal operations, laboratory indicators and imaging results, medical treatment, surgical methods, surgical complications and recurrence were collected. Results: a total of 21 patients (16 males and 5 females) were enrolled in the study, with an average age of 38.9 鹵9.9 (2764) years. The median age of onset was 31 (1850) years old and BMI was 17.7 鹵2.7 (12.6 / 23.3). 1 cases had family history (mother), 2 cases had smoking history. 2 cases had extraintestinal manifestations (oral ulcer) .15 cases of gastroduodenal lesions with CD. There were 6 cases secondary to colon or small intestine. The median time of CD was 8 years (from 1 month to 22 years), and the median time of CD involvement in gastroduodenal lesions was 2 years and 7 months (1 to 15 years). The first diagnosis of CD was accompanied by stomach. 7 patients with duodenal lesions. 12 patients with intestinal surgery history. 15 patients with perianal surgery history. 15 patients with primary CD in gastroduodenum 23.3 (18.1 鹵3.1). Anemia patients with a total of 7 / 15 patients with CD secondary involvement of gastroduodenum BMI 16.0U 18.2 (16.7 鹵0.8) in colon or small intestine, and 6 / 6 cases in anemia. Clinical manifestations: 14 cases with gastric outlet obstruction 2 cases with gastrointestinal perforation 1 case with gastrointestinal fistula 4 cases without gastroduodenal symptoms. The clinical types of CD involvement of gastroduodenum, CD and gastroduodenum were found during the operation. Among the clinical types, 14 cases were stenosis type and 6 cases were penetrating type. Of the 21 patients, 1 case was simple gastroduodenal CD.All the other 20 cases had involvement except gastroduodenum (2 cases of esophagus, 19 cases of small intestine, 12 cases of colon, 2 cases of rectoanal canal). All patients were treated with drugs, of which 4 were treated by endoscopic balloon dilatation. 5 out of 11 patients underwent endoscopic balloon dilatation for gastric outlet obstruction. One patient underwent distal gastrectomy and BII anastomosis. One patient received partial gastrectomy. 2 patients underwent duodenal repair. 4 patients underwent surgical treatment for gastrointestinal fistula. Two patients underwent partial gastrectomy and 2 patients underwent gastric repair. Conclusion the gastric outlet obstruction, gastrointestinal perforation and internal fistula can be seen in the involvement of the gastroduodenum by the weight CD. In patients with primary gastroduodenal and gastroduodenal diseases, infliximab combined with enteral nutrition support and endoscopic dilatation can be used for the treatment of mild and moderate gastroduodenal stenosis. Short-circuit gastrointestinal surgery or partial resection to avoid acute gastrointestinal perforation and other complications. Patients with gastroduodenal CD secondary to small intestine or colon can be found partly by imaging and partly by surgical exploration. Fistula can be surgically resected and partly gastrectomy or duodenal repair can be performed.
【學(xué)位授予單位】：浙江大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R656

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