Objectives: As a type of inflammatory bowel disease, Crohn's disease (CD) is characterized by jumping lesions and transmural inflammation. The treatment goal is to control the development of inflammation with drugs such as 5-Amino Salicylic Acid, azathioprine and hormones, but most patients still need surgical treatment eventually. The surgical treatment of CD requires exquisite surgical design and solid surgical procedures to minimize the progression of intestinal lesions and preserve the normal bowel segment as much as possible. This study aims to summarize and discuss the surgical treatments for intestinal CD, and to provide references for the surgical treatment of intestinal CD.
Methods: Clinical data of 122 patients with CD were analyzed retrospectively. They all received surgical treatments in the Second Xiangya Hospital of Central South University between Jan. 1, 2015 and Jan. 1, 2021. The data included general information, clinical manifestations, preoperative examination, preoperative preparation, surgical methods, pathological examination, complications, and follow-up data.
Results: Except 1 case of emergency surgery, all the other patients met the surgical indications of intestinal CD after multi-disciplinary discussion (MDT) and they were transferred to surgery for elective surgery, and received high-quality intestinal preparation before surgery. Among them, 99 cases underwent one-stage abdominal operation and 23 cases underwent the second abdominal operation. All patients underwent successful surgery with good surgical results, with significantly alleviated clinical symptoms and the BMI significantly increased compared with those before surgery. There were 14 cases (11.5%) of postoperative complications. One case of delayed anastomotic fistula and one case of small intestinal cutaneous fistula which were successfully treated by conservative treatment, the other 12 cases were successfully treated by reoperation, and there were no complications with follow-up operation. The postoperative pathological diagnosis for all patients was clear. All patients received regular follow-up with 5-70 (median 36) months and no clinical recurrence was found.
Conclusions: As the surgical treatment of intestinal CD, surgeons should strictly grasp the surgical indications based on the MDT. During the operation of small intestinal CD, it is advisable to preserve bowel segment as much as possible. For patients with short remaining normal bowel segment, the intestinal canal should be preserved as far as possible, even for the mildly diseased bowel, so as to avoid the occurrence of short bowel syndrome and leave room for possible reoperation. In the treatment of secondary duodenal CD, it is necessary to carefully identify the nature of the local lesions. Different surgical treatments should be performed according to whether there is an internal fistula and the size of this fistula. Meanwhile, duodenectomy or pancreaticoduodenectomy should be considered as the final surgical method in the treatment of primary duodenal CD.
目的: 克罗恩病(Crohn’s disease，CD)是一种炎症性肠病，以跳跃性病变和跨壁炎症为临床特征，其治疗目标是通过药物如5-氨基水杨酸、硫唑嘌呤、激素等来控制炎症的发展，但大多数患者最终仍需要接受外科手术治疗。CD的外科手术治疗需要精妙的手术设计和扎实的操作技术以最大限度地控制肠道病变进展，并尽量保留正常肠段。本研究旨在总结和探讨肠道CD的外科治疗策略，以期为肠道CD的外科治疗提供参考。方法: 回顾性分析2015年1月1日至2021年1月1日在中南大学湘雅二医院接受手术治疗的122例肠道CD患者的一般资料、临床表现、术前检查、术前准备、手术方式、病理检查、术后并发症及随访资料。结果: 除1例急诊手术外，其他患者均经多学科联合会诊(multi-disciplinary treatment，MDT)讨论确定符合肠道CD外科手术指征后转外科行择期肠道手术，并在术前接受高质量的肠道准备。其中一期腹部手术99例，再次腹部手术23例。所有患者手术顺利，手术效果良好，临床症状较术前明显缓解，BMI较术前明显升高。术后并发症14例(11.5%)，1例延迟性吻合口瘘和1例小肠皮肤瘘经保守治疗成功，其余12例经再次手术处理成功，无后续手术相关并发症。所有患者的术后病理诊断明确；术后均接受定期随访5~70(中位时间36)个月，无临床复发。结论: 对于肠道CD，外科医生应在MDT指导下严格把握手术指征。在小肠CD的手术中，需注意保护肠管；对于剩余正常肠段较短的患者，应尽可能保留肠管甚至轻度病变肠管，以避免短肠综合征的发生，并为可能的再次手术留有余地。在处理继发性十二指肠型CD时，需小心甄别局部病变的性质，根据有无内瘘形成以及瘘口大小进行不同的处理。在处理原发性十二指肠型CD时，应将十二指肠切除术或胰十二指肠切除术视为最终的手术方法。.
Keywords: inflammatory bowel disease; intestinal Crohn’s disease; surgical treatment.