Surgery for luminal Crohn's disease
Surgery for luminal Crohn's disease
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DOI：
10.3748/wjg.v20.i1.78
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发表时间：
2014-01-07
影响因子：
4.3
通讯作者：
Watanabe, Toshiaki
中科院分区：
文献类型：
--
作者：
Yamamoto, Takayuki;Watanabe, Toshiaki
许多克罗恩病（CD）患者需要手术治疗。手术适应症包括药物治疗失败、肠梗阻、瘘管或脓肿形成。最常见的外科手术是切除。在空回肠CD中，狭窄成形术是一种可接受的手术技术，可缓解梗阻症状，同时保留肠道长度并避免发生短肠综合征。然而，狭窄成形术在十二指肠和结肠疾病中的作用仍存在争议。在广泛性结肠炎中，全结肠切除加回肠直肠吻合术（伊拉）后，复发率和功能结局是合理的。对于广泛性结肠炎和直肠受累的患者，全结肠切除术和回肠末端造口术是安全有效的;然而，少数患者可能会发生后续伊拉，一半的患者需要以后进行直肠切除术。直肠结肠切除术与会阴伤口延迟愈合的高发生率相关，但其复发率低。行直肠结肠切除回肠贮袋肛管吻合术的患者功能结局差，失败率高。腹腔镜手术已被引入作为一种微创手术。接受腹腔镜手术的患者肠功能恢复更快，住院时间更短。与开放手术相比，其发病率也较低，疾病复发率相似。(C)2014百世登出版集团有限公司有限公司All rights reserved.
Many patients with Crohn's disease (CD) require surgery. Indications for surgery include failure of medical treatment, bowel obstruction, fistula or abscess formation. The most common surgical procedure is resection. In jejunoileal CD, strictureplasty is an accepted surgical technique that relieves the obstructive symptoms, while preserving intestinal length and avoiding the development of short bowel syndrome. However, the role of strictureplasty in duodenal and colonic diseases remains controversial. In extensive colitis, after total colectomy with ileorectal anastomosis (IRA), the recurrence rates and functional outcomes are reasonable. For patients with extensive colitis and rectal involvement, total colectomy and end-ileostomy is safe and effective; however, a few patients can have subsequent IRA, and half of the patients will require proctectomy later. Proctocolectomy is associated with a high incidence of delayed perineal wound healing, but it carries a low recurrence rate. Patients undergoing proctocolectomy with ileal pouch-anal anastomosis had poor functional outcomes and high failure rates. Laparoscopic surgery has been introduced as a minimal invasive procedure. Patients who undergo laparoscopic surgery have a more rapid recovery of bowel function and a shorter hospital stay. The morbidity also is lower, and the rate of disease recurrence is similar compared with open procedures. (C) 2014 Baishideng Publishing Group Co., Limited. All rights reserved.