Gastroduodenal fistulas in Crohn's disease - Clinical features and management
Gastroduodenal fistulas in Crohn's disease - Clinical features and management
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DOI：
10.1007/bf02258230
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发表时间：
1998-10-01
影响因子：
3.9
通讯作者：
Keighley, MRB
中科院分区：
文献类型：
--
作者：
Yamamoto, T;Bain, IM;Keighley, MRB
本研究的目的是评估克罗恩病患者胃和十二指肠瘘管的临床特征和处理。方法：回顾性分析1958年至1997年间本科收治的14例胃十二指肠瘘合并克罗恩病患者的病历。结果：6例患者术前诊断为胃十二指肠瘘，而8例患者在远端克罗恩病手术中发现胃十二指肠瘘。6例患者的瘘管起源于横结肠的克罗恩病，6例患者的瘘管起源于回肠结肠吻合处的复发性疾病；这些患者没有胃十二指肠克罗恩病的明显证据。1例患者在接受药物治疗后，回肠-十二指肠瘘管闭合。其余11例患者行病变肠切除术和胃或十二指肠瘘闭合。其余2个瘘管位于十二指肠至腹壁；两人都患有原发性克罗恩氏十二指肠炎。对1例十二指肠皮瘘行清创术，单纯封闭缺损；另一例则行瘘管周围部分十二指肠切除及十二指肠空肠吻合术。所有患者胃十二指肠瘘管均治愈，无瘘管复发。结论：对于胃十二指肠瘘管，一般建议简单关闭胃十二指肠部分的瘘管。然而，当瘘管周围十二指肠切除后缺损较大时，在没有空肠克罗恩病证据的情况下，建议进行十二指肠空肠吻合。
The aim of this study was to assess the clinical features and management of fistulas involving the stomach and duodenum (gastroduodenal fistulas) in patients with Crohn's disease. METHODS: The medical records of 14 patients with a gastroduodenal fistula complicating Crohn's disease treated in this unit between 1958 and 1997 were reviewed. RESULTS: In six patients a gastroduodenal fistula was diagnosed before surgery, whereas eight gastroduodenal fistulas were discovered during surgery for distal Crohn's disease. In six patients, the fistula originated from Crohn's disease in the transverse colon, and in six patients, it originated from a recurrent disease at an ileocolonic anastomosis; these patients had no gross evidence of gastroduodenal Crohn's disease. In one patient, the ileocolonic-duodenal fistula closed on medical treatment. The other 11 patients underwent resection of the diseased bowel and closure of the gastric or duodenal fistulas. The two remaining fistulas were from the duodenum to the abdominal wall; both had primary Crohn's duodenitis. One duodenocutaneous fistula was treated by debridement of the duodenal fistula and simple closure of the defect; the other was treated by limited duodenal excision around the fistula and by duodenojejunostomy. In all patients, gastroduodenal fistulas were cured, and there have been no fistula recurrences. CONCLUSIONS: Simple closure of the gastroduodenal component of the fistula is generally advised for gastroduodenal fistulas. However, when the duodenal defect after excision around the fistula is large, duodenojejunostomy is recommended, provided there is no evidence of jejunal Crohn's disease.