LONG-TERM FOLLOW-UP OF PATIENTS WITH CROHNS-DISEASE - RELATIONSHIP BETWEEN THE CLINICAL-PATTERN AND PROGNOSIS
LONG-TERM FOLLOW-UP OF PATIENTS WITH CROHNS-DISEASE - RELATIONSHIP BETWEEN THE CLINICAL-PATTERN AND PROGNOSIS
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DOI：
10.1016/0016-5085(85)90006-x
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发表时间：
1985-01-01
期刊：
影响因子：
29.4
通讯作者：
FAZIO, VW
中科院分区：
文献类型：
--
作者：
FARMER, RG;WHELAN, G;FAZIO, VW
1966-1969年在克利夫兰诊所[美国]连续诊断的615例克罗恩病新患者的研究中，观察了592例患者（平均> 13年，最短7年），随访率为96.3%。最初的假设是，最初的解剖受累（临床模式）直接影响临床病程和预后。疾病部位如下：回结肠246例，小肠165例，结肠/肛门直肠181例。在回结肠疾病患者中，225例（91.5%）接受了手术。小肠型手术率为65.5%，结肠/肛门直肠型手术率为58%。手术的具体原因包括：回结肠型的内瘘伴脓肿或肠梗阻;小肠型的肠梗阻;结肠/肛门直肠型的严重肛周疾病或中毒性巨结肠。非手术患者的并发症包括肛周瘘和肠外表现。治疗类型、治疗时间与预后无相关性。发生死亡（75例）（12.8%），其中36例与克罗恩病直接相关。即使多年后，症状仍在继续，手术患者的生活质量往往不理想。对于非手术患者，最有利的生活质量的经验与结肠或回肠节段性参与。预后不良与回结肠疾病和内瘘引起的脓毒症有关。
In a study of 615 new patients with Crohn''s disease consecutively diagnosed at the Cleveland Clinic [USA] from 1966-1969, 592 patients were observed (mean > 13 yr, minimum 7 yr), giving a follow-up rate of 96.3%. The original hypothesis was that initial anatomic involvement (the clinical pattern) bears directly on clinical course and prognosis. Disease sites were as follows: 246 ileocolic, 165 small intestine and 181 colon/anorectal. Among patients with ileocolic disease, 225 (91.5%) had surgery. For the small intestine pattern, the operative incidence was 65.5%; for the colon/anorectal pattern, it was 58%. Operations were for specific reasons: internal fistula with abscess or intestinal obstruction for ileocolic pattern; intestinal obstruction for small intestine pattern; and severe perianal disease or toxic megacolon for colon/anorectal pattern. Complications among nonoperated patients included perianal fistulas and extraintestinal manifestations. No statistical correlation existed between type and duration of medical treatment and prognosis. Deaths (75) occurred (12.8%), 36 of which related directly to Crohn''s disease. Even after many years, symptoms continued, and the quality of life tended to be suboptimal among operated patients. For nonoperated patients, the most favorable quality of life was experienced by those with segmental involvement of the colon or ileum. Poor prognosis correlated with ileocolic disease and the presence of sepsis because of an internal fistula.