克罗恩病累及胃十二指肠的外科治疗

发布时间：2018-06-28 02:49

本文选题：克罗恩病 + 胃十二指肠　；参考：《浙江大学》2017年硕士论文

【摘要】：研究目的与背景:克罗恩病(Crohn's Disease,CD)是一种反复发作的,慢性非特异性肠道炎症性病变为主的全身性疾病,其发病率逐年上升,但发病机制目前尚未明确。CD可累及全消化道,最常累及末端回肠,累及胃十二指肠的患者相对较少,本文旨在探究CD累及胃十二指肠的病变特点及外科治疗方式;方法:回顾性收集2009年1月至2017年2月浙江大学医学院附属邵逸夫医院炎症性肠病中心治疗过的确诊为CD且累及胃十二指肠的患者。收集其一般资料,临床表现,患病时间,肛周病变史,既往肠道手术史,实验室指标及影像学结果,内科治疗情况,手术方式;手术并发症及复发情况;结果:共有21例患者纳入研究(男16,女5),平均年龄为38.9±9.9(27～64)岁,中位发病年龄为31(18～50)岁,BMI 17.7±2.7(12.6～23.3)。1例患者有家族史(母亲),2例患者有吸烟史。2例患者有肠外表现(口腔溃疡)。CD胃十二指肠病变原发的有15例,继发于结肠或小肠的有6例。CD患病时间中位时间为8年(1月至22年),诊断CD累及胃十二指肠病变时间中位时间为2年7个月(1月至15年),首次诊断CD时就伴有胃十二指肠病变的有7例患者。12例患者有肠道手术病史,15例患者有肛周手术史。15例CD原发于胃十二指肠的患者,BMI12.6～23.3(18.1±3.1),贫血患者总共7/15例;6例CD累及胃十二指肠继发于结肠或小肠的患者,BMI16.0～18.2(16.7±0.8),贫血患者总共6/6例。临床表现:14例患者发生胃出口梗阻,2例消化道穿孔,1例检查发现结肠胃瘘,4例患者无胃十二指肠症状,术中才发现CD累及胃十二指肠。CD累及胃十二指肠的临床类型中有14例患者是狭窄型,6例患者是穿透型,另有1例患者合并有狭窄型和穿透型。21例患者中1例为单纯胃十二指肠CD,其余20例患者均有除了胃十二指肠外累及(食管2例,小肠19例,结肠12例,直肠肛管2例)。所有患者均采用药物治疗,其中4例患者行内镜下球囊扩张术。11例手术治疗的患者中共有5例患者因胃出口梗阻行手术治疗,其中3例患者行幽门狭窄成形术,1例患者行远端胃切除+BII式吻合术,1例患者行胃部分切除术。2例行十二指肠修补术。4例患者因出现胃肠瘘行手术治疗,其中2例患者行胃部分切除术,2例患者行胃修补术。结论:CD累及胃十二指肠可表现为胃出口梗阻、消化道穿孔、内瘘形成等。原发于胃及十二指肠的患者,英夫利昔单抗联合肠内营养支持及内镜扩张等等可治疗轻中度胃十二指肠狭窄型病变,内科治疗无效需要外科治疗,手术方式可行狭窄成形术,胃肠短路术或部分切除术,避免出现急性消化道穿孔等并发症。继发于小肠或结肠的胃十二指肠CD患者,部分可通过影像学检查发现,部分于手术探查中发现,可手术切除瘘管,行胃部分切除或十二指肠修补。
[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 卤9.9 (2764) years. The median age of onset was 31 (1850) years old and BMI was 17.7 卤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 卤3.1). Anemia patients with a total of 7 / 15 patients with CD secondary involvement of gastroduodenum BMI 16.0U 18.2 (16.7 卤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.
【学位授予单位】：浙江大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R656

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