中华消化外科杂志
中華消化外科雜誌
중화소화외과잡지
CHINESE JOURNAL OF DIGESTIVE SURGERY
2013年
7期
516-519
,共4页
胡健聪%何晓生%曾杨%练磊%吴小剑%兰平
鬍健聰%何曉生%曾楊%練磊%吳小劍%蘭平
호건총%하효생%증양%련뢰%오소검%란평
克罗恩病%肛瘘%外科治疗%内科治疗
剋囉恩病%肛瘺%外科治療%內科治療
극라은병%항루%외과치료%내과치료
Crohn's disease%Anal fistula%Surgical treatment%Medical treatment
目的 探讨克罗恩病合并肛瘘的合理治疗方法.方法 回顾性分析2007年6月至2011年4月中山大学附属第六医院收治的33例克罗恩病合并肛瘘或肛周脓肿患者的临床资料.根据克罗恩病合并肛瘘的活动程度及病变范围,本研究采用外科治疗、内科治疗以及外科联合内科治疗.外科治疗方式包括肛瘘挂线术、肛瘘切除术、肛周脓肿切开引流术以及肠造口术.针对克罗恩病患者肠道病变选用5-氨基水杨酸类药物、免疫抑制剂、糖皮质激素治疗、TNF单克隆抗体等药物进行内科治疗.治疗后采用门诊治疗和电话方式随访至2012年8月.术前及术后克罗恩病活动指数(CDAI)、肛周克罗恩病活动指数(PDAI)采用独立样本t检验比较.结果 33例患者中,22例行外科联合内科治疗,7例行单纯外科治疗,4例行单纯内科治疗.首次治疗后18例患者肛瘘瘘口愈合(其中3例行单纯内科治疗),愈合时间为(3.2±2.6)个月(1 ～12个月),其中8例瘘管减少、症状改善；4例瘘口持续未闭；6例出现肛瘘复发或再发,复发或再发时间为首次治疗后(35±56)个月(5～ 148个月).33例患者术前CDAI和PDAI评分分别为(166±100)分(7～ 361分)和(9.2±2.6)分(5～16)分,经治疗后(包括手术及药物治疗)CDAI和PDAI评分分别为(83±53)分(0 ～212分)和(2.7±3.1)分(0～11分),患者治疗前后CDAI和PDAI评分比较,差异有统计学意义(t=4.20,8.92,P＜0.05).12例首次治疗肛瘘未愈合患者再次治疗后,3例愈合,9例未愈合.6例患者出现复发或再发,其中5例接受再次手术治疗(4例愈合、1例症状改善),1例仅接受内科治疗瘘口未愈合.直至随访结束,30例患者中20例肛瘘愈合,10例肛瘘未愈合.结论 目前尚无统一的克罗恩病合并肛瘘治疗标准,外科联合内科治疗克罗恩病合并肛瘘疗效较好,手术方式需根据患者具体情况慎重选择.
目的 探討剋囉恩病閤併肛瘺的閤理治療方法.方法 迴顧性分析2007年6月至2011年4月中山大學附屬第六醫院收治的33例剋囉恩病閤併肛瘺或肛週膿腫患者的臨床資料.根據剋囉恩病閤併肛瘺的活動程度及病變範圍,本研究採用外科治療、內科治療以及外科聯閤內科治療.外科治療方式包括肛瘺掛線術、肛瘺切除術、肛週膿腫切開引流術以及腸造口術.針對剋囉恩病患者腸道病變選用5-氨基水楊痠類藥物、免疫抑製劑、糖皮質激素治療、TNF單剋隆抗體等藥物進行內科治療.治療後採用門診治療和電話方式隨訪至2012年8月.術前及術後剋囉恩病活動指數(CDAI)、肛週剋囉恩病活動指數(PDAI)採用獨立樣本t檢驗比較.結果 33例患者中,22例行外科聯閤內科治療,7例行單純外科治療,4例行單純內科治療.首次治療後18例患者肛瘺瘺口愈閤(其中3例行單純內科治療),愈閤時間為(3.2±2.6)箇月(1 ～12箇月),其中8例瘺管減少、癥狀改善；4例瘺口持續未閉；6例齣現肛瘺複髮或再髮,複髮或再髮時間為首次治療後(35±56)箇月(5～ 148箇月).33例患者術前CDAI和PDAI評分分彆為(166±100)分(7～ 361分)和(9.2±2.6)分(5～16)分,經治療後(包括手術及藥物治療)CDAI和PDAI評分分彆為(83±53)分(0 ～212分)和(2.7±3.1)分(0～11分),患者治療前後CDAI和PDAI評分比較,差異有統計學意義(t=4.20,8.92,P＜0.05).12例首次治療肛瘺未愈閤患者再次治療後,3例愈閤,9例未愈閤.6例患者齣現複髮或再髮,其中5例接受再次手術治療(4例愈閤、1例癥狀改善),1例僅接受內科治療瘺口未愈閤.直至隨訪結束,30例患者中20例肛瘺愈閤,10例肛瘺未愈閤.結論 目前尚無統一的剋囉恩病閤併肛瘺治療標準,外科聯閤內科治療剋囉恩病閤併肛瘺療效較好,手術方式需根據患者具體情況慎重選擇.
목적 탐토극라은병합병항루적합리치료방법.방법 회고성분석2007년6월지2011년4월중산대학부속제륙의원수치적33례극라은병합병항루혹항주농종환자적림상자료.근거극라은병합병항루적활동정도급병변범위,본연구채용외과치료、내과치료이급외과연합내과치료.외과치료방식포괄항루괘선술、항루절제술、항주농종절개인류술이급장조구술.침대극라은병환자장도병변선용5-안기수양산류약물、면역억제제、당피질격소치료、TNF단극륭항체등약물진행내과치료.치료후채용문진치료화전화방식수방지2012년8월.술전급술후극라은병활동지수(CDAI)、항주극라은병활동지수(PDAI)채용독립양본t검험비교.결과 33례환자중,22례행외과연합내과치료,7례행단순외과치료,4례행단순내과치료.수차치료후18례환자항루루구유합(기중3례행단순내과치료),유합시간위(3.2±2.6)개월(1 ～12개월),기중8례루관감소、증상개선；4례루구지속미폐；6례출현항루복발혹재발,복발혹재발시간위수차치료후(35±56)개월(5～ 148개월).33례환자술전CDAI화PDAI평분분별위(166±100)분(7～ 361분)화(9.2±2.6)분(5～16)분,경치료후(포괄수술급약물치료)CDAI화PDAI평분분별위(83±53)분(0 ～212분)화(2.7±3.1)분(0～11분),환자치료전후CDAI화PDAI평분비교,차이유통계학의의(t=4.20,8.92,P＜0.05).12례수차치료항루미유합환자재차치료후,3례유합,9례미유합.6례환자출현복발혹재발,기중5례접수재차수술치료(4례유합、1례증상개선),1례부접수내과치료루구미유합.직지수방결속,30례환자중20례항루유합,10례항루미유합.결론 목전상무통일적극라은병합병항루치료표준,외과연합내과치료극라은병합병항루료효교호,수술방식수근거환자구체정황신중선택.
Objective To investigate the comprehensive treatment of Crohn's disease complicated with anal fistula.Methods The clinical data of 33 patients with Crohn's disease complicated with anal fistula who were admitted to the Sixth Hospital of Sun Yat-Sen University from June 2007 to April 2011 were retrospectively analyzed.According to the range of the disease,surgical,medical and combined treatment were applied.Surgical treatment included thread-drawing drainage,fistulectomy,incision and drainage of the perianal abscess and enterostomy.Medical treatment include 5-aminosalicylic acid,immunosuppressive therapy,glucocorticoid,tumor necrosis factor monoclonal antibodies.All the patients were followed up till August 2012.The Crohn's disease activity index (CDAI) and perianal Crohn's disease activity index (PDAI) before and after treatment were analyzed using the independent sample t test.Results Of the 33 patients,22 received surgical and medical treatment,7 received surgical treatment,and 4 received medical treatment.The anal fistula was healed in 18 patients after the initial treatment (3 of them did not receive surgical treatment),and the mean closure time of the fistula was (3.2 ± 2.6) months (range,1-12 months) ; the condition of 8 patients was improved ; 4 patients suffered from fistula persistence ; anal fistula recurrence was observed in 6 patients,and the time for anal fistula recurrence was (35 ±56)months (range,5-148 months).The preoperative CDAI and PDAI of the 33 patients were 166 ± 100 (range,7-361) and 9.2 ± 2.6 (range,5-16),and the postoperative CDAI and PDAI of the 33 patients were 83 ± 53 (range,0-212) and 2.7 ± 3.1 (range,0-11).There were significant differences between the pre-and postoperative CDAI and PDAI (t =4.20,8.92,P ＜0.05).Of the 12 patients who were failed in the initial treatment,the anal fistula was healed in 3 patients after the treatment,and the condition of the other 9 patients remained the same.Of the 6 patients with anal fistula recurrence,5 received reoperation (4 were healed and 1 remained the same after the treatment) and the fistula of 1 patient who received medical treatment was not healed.At the end of the follow up,the anal fistulas of 20 patients were healed,and 10 remained the same.Conclusions There is no standard treatment for Crohn's disease complicated with anal fistula,surgical treatment combined with medical treatment is important for the treatment of Crohn's disease complicated with anal fistula.Surgical procedures should be chosen carefully according to the condition of the patients.
