Role of strictureplasty in surgical treatment of Crohn's disease
Role of strictureplasty in surgical treatment of Crohn's disease
复制标题
DOI：
10.1007/bf02990577
复制
发表时间：
2005-03-01
影响因子：
6.3
通讯作者：
Arima, S
中科院分区：
文献类型：
--
作者：
Futami, K;Arima, S
背景本研究的目的是回顾克罗恩病患者狭窄成形术的早期和晚期结果。方法.我们回顾了103例接受293次狭窄成形术的阻塞性克罗恩病患者（Heineke-Mikulicz，235例; Finney，22例; Jaboulay，35例;侧侧等蠕动狭窄成形术，1例）。手术时的平均年龄为31.4岁。44例患者既往至少接受过一次手术，62例患者同时接受了其他手术。单纯狭窄成形术41例，共行狭窄成形术154例。狭窄成形术治疗的狭窄部位和数量如下：十二指肠（2）、小肠（265）、回盲部（6）、结肠（4）、既往吻合口复发（11）和既往狭窄成形术复发（5）。每例患者的平均结构成形术次数为2.8次。再次手术已被用作复发的明确终点，并对狭窄成形术的长期结局进行了检查。结果无手术死亡。4例患者发生与狭窄成形术相关的感染性并发症，2例患者（1.9%）需要再次手术。平均随访时间为80.3个月。所有患者的5年和10年再手术率分别为45.0%和61.9%。45例（43.7%）患者因复发而需要进一步手术，其中21例（43.7%）患者因复发而需要进一步手术。狭窄处复发14例（20.4%），其中狭窄14例，穿孔7例。与Heineke-Mikulicz相比，Finney或Jabouley手术治疗部位的穿孔性疾病复发更频繁。结论.人们认为，从长远来看，如果仔细选择狭窄部位，狭窄成形术在克罗恩病的手术治疗中对于保留肠道是安全且有用的。
Background. The aim of this study was to review early and late results of strictureplasty for patients affected by Crohn's disease. Methods. We reviewed 103 patients with obstructive Crohn's disease undergoing 293 strictureplasties (Heineke-Mikulicz, 235; Finney, 22; Jaboulay, 35; side-to-side isoperistaltic strictureplasty, 1). Mean age at surgery was 31.4 years. Forty-four patients had at least one previous surgery, and synchronous other surgical procedures were performed in 62 patients. For 41 patients with strictureplasty alone, 154 strictureplasties were done. The site and number of strictures treated by strictureplasty were as follows: duodenum (2), small intestine (265), ileocecal region (6), colon (4), recurrence at previous anastomosis (11), and recurrence at previous strictureplasty (5). The mean number of structureplasties per patient was 2.8. Reoperation has been used as the definitive endpoint for recurrence, and the long-term outcome of strictureplasty was examined. Results. There was no operative mortality. Septic complications related to strictureplasty developed in 4 patients and reoperation was needed in 2 patients (1.9%). Mean duration of follow-up was 80.3 months. For all patients, the 5- and 10-year reoperation rate was 45.0% and 61.9%, respectively. Forty-five patients (43.7%) required further operation for recurrence, of whom 21. patients (20.4%) had recurrence at the site of strictureplasty, which was restricture in 14 patients and perforating disease in 7 patients. Perforating disease for recurrence was more frequent at the site treated by the Finney or Jabouley procedure compared with Heineke-Mikulicz. Conclusions. It is considered that, in the long term, strictureplasty is safe and useful for preserving the intestine in the surgical treatment of Crohn's disease if strictures are carefully selected.