Sharif H, Alexander-Williams J
General Hospital, Birmingham, U.K.
Int Surg. 1992 Jan-Mar;77(1):15-8.
Crohn's disease is a panintestinal disease of unknown aetiology and a tendency to recrudescence throughout the patient's life. It is therefore impossible to cure Crohn's disease by medical therapy or surgical excision. In spite of this, the majority of patients can be managed through their disease and maintained in a good state of health by a combination of medical and surgical treatment. Early attempts at surgical management of Crohn's disease in the 1930's and 1940's involved bypass procedures which were marred with serious complications of sepsis, development of cancer and increased rate of recurrence. By the 1950's resection became the preferred operation but there soon arose a controversy about the amount of bowel that should be removed. There were some who advocated radical excision; removing all diseased bowel with a large margin of apparently normal tissue on each side of the resection. Others found less radical resection safer as it preserved gut and also had no apparent effect on the rate of recurrence of the disease. Although this argument continued, the balance gradually shifted towards less radical surgery. Furthermore, the wave of conservatism led to the evolution of the concept of minimal surgery.
克罗恩病是一种病因不明的全肠道疾病，患者一生中易复发。因此，药物治疗或手术切除都无法治愈克罗恩病。尽管如此，大多数患者可以通过药物和手术联合治疗来控制病情，保持良好的健康状态。20世纪30年代和40年代，早期对克罗恩病进行手术治疗的尝试包括旁路手术，但这些手术伴随着败血症、癌症发生和复发率增加等严重并发症。到了20世纪50年代，切除术成为首选手术，但很快就出现了关于应切除肠段长度的争议。有些人主张根治性切除；切除所有患病肠段，并在切除部位两侧各保留一大块明显正常的组织。另一些人则认为，不太激进的切除更安全，因为它保留了肠道，而且对疾病复发率没有明显影响。尽管这场争论仍在继续，但天平逐渐向不太激进的手术倾斜。此外，保守主义浪潮导致了微创外科概念的演变。
