Ileal Crohn's disease is best treated by surgery
Ileal Crohn's disease is best treated by surgery
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回肠克罗恩病最好通过手术治疗
作者：
A. C. Windsor
克罗恩病的最佳治疗仍然是复杂和有争议的。与其他良性疾病一样，治疗取决于治疗风险和益处之间的平衡。不幸的是，在外科手术中，风险/收益平衡的风险部分似乎占主导地位。外科医生和内科医生似乎都很关注手术干预的并发症，包括疾病复发、吻合口破裂、肠皮瘘和短肠综合征。针对这一点，“传统观点”目前认为，对无并发症的克罗恩病的初始治疗应该是医学治疗，只有在出现梗阻或瘘管等并发症时，或在一段时间的医学治疗后出现时，才需要手术治疗。这种方法没有认识到早期手术的好处和延迟手术的潜在有害影响。多年来，克罗恩病的主要医疗管理一直是皮质类固醇和5- asa。在克罗恩病中越来越多地使用免疫抑制疗法，以及最近出现的一些新疗法，如白细胞介素10和抗肿瘤坏死因子（TNF）抗体，可能只会进一步降低手术在治疗途径中的地位，并进一步支持医生的错误信念，即医疗管理可能在未来能够治愈克罗恩病，并完全消除手术干预的需要。
The optimal management of Crohn's disease remains complicated and controversial. In common with other benign conditions, treatment is dependent on a balance between therapeutic risk and benefit. Unfortunately, in surgery the risk arm of the risk/benefit balance appears to predominate. Clinicians, both surgical and medical, seem preoccupied by the complications of surgical intervention, including disease recurrence, anastomotic breakdown, enterocutaneous fistula, and short bowel syndrome. In response to this, “conventional wisdom” currently dictates that the initial management of uncomplicated Crohn's disease should be medical, and only when complications, such as obstruction or fistulation, are apparent either at presentation or develop following a period of medical management is surgery indicated. This approach fails to appreciate the benefits of early surgery and the potentially detrimental effects of delaying surgery. For many years the mainstay of medical management in Crohn's disease has been corticosteroids and 5-ASAs. The increasing use of immunosuppressive therapy in Crohn's and more recently the emergence of a number of novel therapies such as interleukin 10 and anti-tumour necrosis factor (TNF) antibody may serve only to demote surgery further down the management pathway and further support the physician's mistaken belief that medical management may in future be able to cure Crohn's disease and obviate, entirely, the need for surgical intervention.
There is an extensive body of literature to support the precept that surgical intervention in Crohn's disease is not without risk.1,2 However, it is apparent that approximately 80% of patients presenting with ileal …