Yamamoto T, Bain I M, Connolly A B, Allan R N, Keighley M R
University Department of Surgery, Queen Elizabeth Hospital, Edgbaston, Birmingham, UK.
Br J Surg. 1999 Feb;86(2):259-62. doi: 10.1046/j.1365-2168.1999.01022.x.
The outcome of strictureplasty for duodenal Crohn's disease has not been critically documented. The aim of this study was to assess the outcome of strictureplasty for duodenal Crohn's disease.
A retrospective review was undertaken of 13 patients who underwent strictureplasty (including four pyloroplasties) for obstructive duodenal Crohn's disease between 1974 and 1997.
Ten patients underwent strictureplasty as the primary procedure, and in three strictureplasty was used as a revision procedure after previous bypass surgery. Two patients developed anastomotic breakdown and were treated either by Roux-en-Y duodenojejunostomy or partial gastrectomy. Symptoms of obstruction persisted in four patients after strictureplasty; three eventually resolved after prolonged nasogastric aspiration, but the other required gastrojejunostomy. In the long term, six patients developed restricture at the previous strictureplasty site. Five required repeat strictureplasty and the other patient underwent duodenojejunostomy. One patient who had repeat strictureplasty required a further strictureplasty because of restricture at the previous strictureplasty site. Overall nine of 13 patients required further surgery because of early postoperative complications or restricture at the strictureplasty site.
Strictureplasty for duodenal Crohn's disease is associated with a high incidence of postoperative complications and restricture.
十二指肠克罗恩病狭窄成形术的疗效尚未得到严格记录。本研究的目的是评估十二指肠克罗恩病狭窄成形术的疗效。
对1974年至1997年间因梗阻性十二指肠克罗恩病接受狭窄成形术（包括4例幽门成形术）的13例患者进行回顾性研究。
10例患者将狭窄成形术作为主要手术，3例患者在先前的旁路手术后将狭窄成形术用作修正手术。2例患者发生吻合口破裂，分别接受了Roux-en-Y十二指肠空肠吻合术或部分胃切除术治疗。狭窄成形术后4例患者仍有梗阻症状；3例患者经长时间鼻胃吸引后最终症状缓解，但另1例患者需要进行胃空肠吻合术。长期来看，6例患者在先前狭窄成形术部位出现再狭窄。5例患者需要再次进行狭窄成形术，另1例患者接受了十二指肠空肠吻合术。1例接受再次狭窄成形术的患者因先前狭窄成形术部位再狭窄而需要进一步进行狭窄成形术。总体而言，13例患者中有9例因术后早期并发症或狭窄成形术部位再狭窄而需要进一步手术。
十二指肠克罗恩病狭窄成形术术后并发症和再狭窄的发生率较高。
