NATURAL-HISTORY OF RECURRENT CROHNS-DISEASE AT THE ILEOCOLONIC ANASTOMOSIS AFTER CURATIVE SURGERY
NATURAL-HISTORY OF RECURRENT CROHNS-DISEASE AT THE ILEOCOLONIC ANASTOMOSIS AFTER CURATIVE SURGERY
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DOI：
10.1136/gut.25.6.665
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发表时间：
1984-01-01
期刊：
影响因子：
24.5
通讯作者：
COREMANS, G
中科院分区：
文献类型：
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作者：
RUTGEERTS, P;GEBOES, K;COREMANS, G
在114例患者中进行了内窥镜和组织学研究，通过“治愈性”切除末端回肠和部分结肠治疗克罗恩病，以研究复发性克罗恩病的自然史。在手术后一年内检查的患者中，克罗恩病的复发率为72%。这一数字与术后1 - 3年或3 - 10年检查的患者（分别为79%和77%）没有显著差异。88%的患者复发位于新生末端回肠和吻合口。复发的早期内镜体征是新末端回肠的小阿弗他溃疡。回肠活检在这个阶段显示了一个重要的炎性细胞浸润的固有层与大量的嗜酸性粒细胞和融合和钝化的绒毛。在术后1 - 3年检查的患者中观察到更晚期的病变，包括较大的，通常为匍匐性溃疡和结节性皱褶增厚。在术后3 - 10年检查的患者中，吻合口经常狭窄和僵硬，大溃疡从狭窄处延伸到结肠。粘液肉芽肿可在正常粘膜和溃疡周围明显发炎的粘膜中发现。这些研究表明，克罗恩病的复发几乎总是在手术后的第一年发生。可能存在明显的内窥镜病变而没有临床症状，特别是在疾病的早期阶段。
An endoscopical and histological study was carried out in 114 patients, treated by 'curative' resection of the terminal ileum and part of the colon for Crohn's disease, in order to study the natural history of recurrent Crohn's disease. The recurrence rate of Crohn's disease in patients examined within one year of the operation was 72%. This figure did not differ significantly from that in patients examined one to three years or three to 10 years after surgery (79% and 77% respectively). Recurrence was located in the neoterminal ileum and at the anastomosis in 88% of the patients. Early endoscopic signs of recurrence were small aphthous ulcers in the neoterminal ileum. Ileal biopsies at this stage showed an important inflammatory cell infiltrate of the lamina propria with numerous eosinophils and fusion and blunting of the villi. More advanced lesions observed in patients examined one to three years after surgery, consisted of larger, often serpiginous ulcerations and nodular thickening of folds. In patients examined three to 10 years after the operation, the anastomosis was frequently stenosed and rigid, with large ulcers extending from the stenosis into the colon. Mucosal granulomas may be found in normal appearing mucosa as well as in the obviously inflamed mucosa surrounding the ulcers. These studies suggest that recurrence of Crohn's disease almost always develops in the first year after the operation. Significant endoscopic lesions may be present without clinical symptoms, particularly in the earlier stages of the disease.