Regueiro Miguel
Inflammatory Bowel Disease Center, University of Pittsburgh, School of Medicine, Division of Gastroenterology, Hepatology, and Nutrition, Scaife Hall, Room 566, 3550 Terrace Street, Pittsburgh, PA 15261, USA.
Gastrointest Endosc Clin N Am. 2002 Jul;12(3):621-33. doi: 10.1016/s1052-5157(02)00013-2.
Fistulas in Crohn's disease are classified as internal fistulas, for example, enteroenteric, enterovesical, rectovaginal, and external fistulas, for example, enterocutaneous, perianal, and parastomal. Although radiographic contrast studies are superior to endoscopy for diagnosing fistulas, endoscopic procedures have a definite role in the evaluation and management of fistulizing Crohn's disease. Endoscopy allows for tissue sampling, and provides information regarding the extent and severity of gastrointestinal inflammation, and the presence of such complications as strictures and cancer. Preoperative colonoscopy has particular value in assessing an enterocolonic fistula, and has important implications regarding the type of surgery performed. Endoscopic therapy for Crohn's fistula is less certain, but may allow for dilation of associated strictures, and may someday serve as a better delivery system for targeted anticytokine and immunologically based therapy.
克罗恩病中的瘘管可分为内瘘，例如肠-肠瘘、肠-膀胱瘘、直肠-阴道瘘，以及外瘘，例如肠-皮肤瘘、肛周瘘和造口旁瘘。尽管在瘘管诊断方面，放射造影检查优于内镜检查，但内镜检查在瘘管性克罗恩病的评估和管理中具有明确作用。内镜检查可进行组织采样，并提供有关胃肠道炎症的范围和严重程度以及诸如狭窄和癌症等并发症存在情况的信息。术前结肠镜检查在评估肠-结肠瘘方面具有特殊价值，并且对所施行手术的类型具有重要意义。克罗恩病瘘管的内镜治疗效果尚不确定，但可能有助于扩张相关狭窄，并且未来有一天可能成为靶向抗细胞因子和基于免疫疗法的更好给药系统。
