【摘要】：目的:相比克羅恩病小腸病變相對清晰的手術(shù)策略,結(jié)腸型克羅恩病的手術(shù)切除范圍相對難以把握。本研究擬通過統(tǒng)計本中心2014年5月至2017年5月結(jié)腸型克羅恩病手術(shù)治療資料,分享總結(jié)我院結(jié)腸型克羅恩病外科治療的經(jīng)驗。材料與方法:本研究從本中心2014年5月至2017年5月共計258例經(jīng)外科治療的克羅恩病患者中,篩選出58名結(jié)腸型克羅恩病患者(排除單獨回盲部病變行回盲部切除的患者),收集并統(tǒng)計了以下臨床數(shù)據(jù):年齡,性別,身體體重指數(shù)(BMI),吸煙史,是否急診手術(shù),癥狀出現(xiàn)至手術(shù)時間,既往手術(shù)史,結(jié)腸外病變,術(shù)前、術(shù)后用藥史,術(shù)前CRP、ESR等指標(biāo),手術(shù)指征,手術(shù)方式,手術(shù)切除范圍,術(shù)中出血,手術(shù)時間,術(shù)后住院天數(shù),術(shù)后并發(fā)癥,隨訪復(fù)發(fā)(包括內(nèi)鏡復(fù)發(fā)及外科復(fù)發(fā))情況等。結(jié)果:共計58名結(jié)腸型克羅恩病患者入組,平均年齡31.1歲,男性35例,女性23例,其中52例進行結(jié)腸節(jié)段切除,6例進行結(jié)腸廣泛切除。病變累及或超過左半結(jié)腸的25例,病變局限右半結(jié)腸的33例。全部58名患者無圍手術(shù)期死亡,其中15名患者出現(xiàn)術(shù)后并發(fā)癥。40例患者術(shù)后給予藥物治療預(yù)防復(fù)發(fā)。22例患者隨訪過程中出現(xiàn)內(nèi)鏡復(fù)發(fā),其中5例再次手術(shù)。結(jié)論:結(jié)腸型克羅恩病的手術(shù)治療的基本策略與小腸病變相似,即"節(jié)約腸段",在保證切緣的基礎(chǔ)上采取節(jié)段切除術(shù)。結(jié)腸病變廣泛者需行全結(jié)腸切除或全結(jié)直腸切除術(shù),但廣泛切除并不能完全避免術(shù)后復(fù)發(fā)。結(jié)腸型克羅恩病患者腹腔鏡手術(shù)安全有效,不增加術(shù)后并發(fā)癥。左半結(jié)腸累及的患者造瘺率以及一期吻合術(shù)后復(fù)發(fā)率較高。結(jié)腸型克羅恩病術(shù)后應(yīng)使用藥物預(yù)防復(fù)發(fā)。
[Abstract]:Objective: compared with the clear surgical strategy of Crohn's disease, the resection range of colon Crohn's disease is difficult to grasp. This study aims to sum up the experience of surgical treatment of colonic Crohn's disease in our hospital from May 2014 to May 2017. Materials and methods: from May 2014 to May 2017, 258 surgically treated patients with Crohn's disease were enrolled in this study. A total of 58 patients with colonic Crohn's disease (excluding patients with ileocecal lesions undergoing ileocecal excision) were selected. The following clinical data were collected and counted: age, sex, body mass index (BMI),) smoking history, and emergency surgery. Symptoms occurred to the time of operation, history of operation, extracolonic lesions, preoperative, postoperative medication history, preoperative CRPU ESR, surgical indications, surgical methods, surgical resection range, intraoperative bleeding, operative time, postoperative hospitalization days, etc. Postoperative complications, follow-up recurrence (including endoscopic recurrence and surgical recurrence) and so on. Results: a total of 58 patients with colonic Crohn's disease were enrolled in the study. The mean age was 31.1 years old. There were 35 males and 23 females. Among them, 52 cases underwent colonic segmental resection and 6 cases underwent extensive colectomy. The lesions involved or exceeded the left hemicolon in 25 cases, and in the right hemicolon in 33 cases. All 58 patients died without perioperative period. Of them, 15 patients had postoperative complications. 40 patients received drug therapy to prevent recurrence. 22 patients had endoscopic recurrence during follow-up. 5 of them had reoperation. Conclusion: the basic strategy of surgical treatment of colonic Crohn's disease is similar to that of small intestinal disease, that is, "economizing intestinal segment", and segmental resection is adopted on the basis of ensuring the cutting margin. Patients with extensive colonic lesions need total colectomy or total colorectal resection, but extensive resection does not completely prevent postoperative recurrence. Laparoscopic surgery in patients with colonic Crohn's disease is safe and effective and does not increase postoperative complications. The rate of fistula and recurrence after primary anastomosis were higher in patients with left hemicolon involvement. Drugs should be used to prevent recurrence of colonic Crohn's disease after operation.
【學(xué)位授予單位】：浙江大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R656.9
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本文編號：2198478