克罗恩病合并肛瘘的综合治疗

中国医药导报2014年10月第11卷第29期

CHINA MEDICAL HERALD Vol.11No.29October 2014

·临床研究·

克罗恩病为肠道的炎症性疾病,是肠黏膜上皮细胞对微生物抗原的异常免疫反应引起的慢性肠道炎症,由于肠上皮细胞经常暴露在细菌及其成分下,致病菌或内化的细菌成分与肠上皮细胞起相互反应而启动炎性反应。克罗恩病易引起直肠肛周病变,肛瘘是其中较为常见并发症,相关研究表明,约有10%的克罗恩病患者在初期并发肛瘘,且复发率较高,严重影响患者的生活质量[1]。克罗恩病的病发原因尚未完

全明确,临床治疗具有一定复杂性与困难性,现有临床缺乏全面合理的治疗方案。本研究对克罗恩病合并肛瘘综合治疗的效果进行分析,现将结果报道如下:1资料与方法1.1一般资料

选取东阳人民医院2008年3月~2013年3月收治的克罗恩病合并肛瘘患者共108例,男女比例为67∶41;年龄22~47岁,平均(27.45±3.78)岁;病程1~127个月,平均(31.76±4.69)个月。依照蒙特利尔表分

型,病变部位:末端回肠(L 1)37例(34.26%),结肠(L 2)

克罗恩病合并肛瘘综合治疗的临床分析

蔡巧英1

叶锋2▲

1.浙江省金华市东阳人民医院,浙江金华322109;

2.浙江大学第一附属医院,浙江杭州

310003[摘要]目的观察克罗恩病合并肛瘘综合治疗的临床疗效。方法选取东阳人民医院2008年3月~2013年3月收治的克罗恩病合并肛瘘患者共108例,予综合治疗,观察患者肛门失禁情况、瘘管的愈合时间、症状缓解情况及生物学指标,行2年随访观察手术后遗症发病情况。结果治疗后肛门失禁评分[(3.16±0.58)分]低于治疗前

[(13.67±3.97)分],差异有统计学意义(P <0.05);克罗恩病内镜严重程度指数[(2.03±0.54)分]、克罗恩病简化活动指数[(139.86±34.29)分]、主观症状评分[(1.07±0.53)分]均优于治疗前[(7.89±2.34)、(287.04±95.45)、(2.36±0.75)分],差异有统计学意义(P <0.05);生物学相关指标均优于治疗前,差异有统计学意义(P <0.05);患者瘘管愈合时间为(19.07±8.72)d;出现后遗症7例(6.48%)。结论克罗恩病合并肛瘘采用综合治疗能够实现患者肛门功能的恢复与局部症状的减轻,效果理想,有临床应用价值。[关键词]克罗恩病;肛瘘;综合治疗[中图分类号]R574

[文献标识码]A

[文章编号]1673-7210(2014)10(b)-0035-04

Clinical analysis of comprehensive treatment of Crohn disease complicat⁃ed with anal fistula

CAI Qiaoying 1YE Feng 2▲

1.Dongyang People's Hospital,Zhejiang Province,Jinhua

322109,China;2.The First Affiliated Hospital of Zhejiang

Medical University,Zhejiang Province,Hangzhou 310003,China [Abstract]Objective To observe the clinical effect of comprehensive treatment on anal fistula complicated with Crohn disease.Methods From March 2008to March 2013108patients with Crohn disease complicated with anal fistula ad⁃

mitted and treated in Dongyang People's Hospital were selected and given comprehensive treatment.Anal incontinence,healing time of fistula,remission and biological indicators were observed and a two year long follow-up was given to

observe the incidence of sequelae of operation.Results After the treatment,anal incontinence score was (3.16±0.58)scores,significantly lower than before the treatment (13.67±3.97)scores,the difference was statistically significant (P <0.05).The scores of CDEIS,CDAI and subjective symptom [(2.03±0.54),(139.86±34.29),(1.07±0.53)scores],signifi⁃cantly better than those before treatment [(7.89±2.34),(287.04±95.45),(2.36±0.75)scores],the differences were statisti⁃cally significant (P <0.05).Biological indexes were significantly befter than those before treatment,the differences were

statistically significant (P <0.05).The healing time of fistula of these patients was (19.07±8.72)d and there were 7cas⁃

es (6.48%)with seguelae.Conclusion Comprehensive treatment,in the treatment of anal fistula complicated with Crohn disease is effective in the recovery of anal function and it lessens the local symptoms,which is of the value to be put into clinical application.

[Key words]Crohn disease;Anal fistula;Comprehensive therapy

[基金项目]上海市卫生局科研课题(编号2012028)。▲

通讯作者

35