结肠型克罗恩病的外科治疗
发布时间：2018-08-23 08:24
【摘要】：目的:相比克罗恩病小肠病变相对清晰的手术策略,结肠型克罗恩病的手术切除范围相对难以把握。本研究拟通过统计本中心2014年5月至2017年5月结肠型克罗恩病手术治疗资料,分享总结我院结肠型克罗恩病外科治疗的经验。材料与方法:本研究从本中心2014年5月至2017年5月共计258例经外科治疗的克罗恩病患者中,筛选出58名结肠型克罗恩病患者(排除单独回盲部病变行回盲部切除的患者),收集并统计了以下临床数据:年龄,性别,身体体重指数(BMI),吸烟史,是否急诊手术,症状出现至手术时间,既往手术史,结肠外病变,术前、术后用药史,术前CRP、ESR等指标,手术指征,手术方式,手术切除范围,术中出血,手术时间,术后住院天数,术后并发症,随访复发(包括内镜复发及外科复发)情况等。结果:共计58名结肠型克罗恩病患者入组,平均年龄31.1岁,男性35例,女性23例,其中52例进行结肠节段切除,6例进行结肠广泛切除。病变累及或超过左半结肠的25例,病变局限右半结肠的33例。全部58名患者无围手术期死亡,其中15名患者出现术后并发症。40例患者术后给予药物治疗预防复发。22例患者随访过程中出现内镜复发,其中5例再次手术。结论:结肠型克罗恩病的手术治疗的基本策略与小肠病变相似,即"节约肠段",在保证切缘的基础上采取节段切除术。结肠病变广泛者需行全结肠切除或全结直肠切除术,但广泛切除并不能完全避免术后复发。结肠型克罗恩病患者腹腔镜手术安全有效,不增加术后并发症。左半结肠累及的患者造瘘率以及一期吻合术后复发率较高。结肠型克罗恩病术后应使用药物预防复发。
[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.
【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】：R656.9
，
本文编号：2198478
[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.
【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】：R656.9
，
本文编号：2198478
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