Felder J B, Adler D J, Korelitz B I
Department of Medicine, Lenox Hill Hospital, New York, New York.
Am J Gastroenterol. 1991 Oct;86(10):1450-5.
Steroid therapy is often avoided in the Crohn's disease patient with a palpable abdominal mass, for fear of dissemination of infection, should the mass prove to contain an abscess. In the present study, 24 patients with Crohn's disease and a palpable abdominal mass were treated with high dose steroids. In 15, the mass resolved completely and, in another nine, it decreased in size by at least 50%. Fourteen of 24 patients eventually required resection for persistence or recurrence of Crohn's disease activity with or without the abdominal mass, but in all the operation was performed electively. At least eight patients never required resection during a mean follow-up period of 40 months. In 13 patients, the mass was later proved to actually contain an abscess cavity. No complications attributable to steroid therapy were seen in either the operative or nonoperative group. Clinicians should not fear using high dose ACTH/corticosteroids to treat severe Crohn's disease with an abdominal mass, if indicated, as it is both safe and effective whether an abscess cavity is present or not.
对于患有可触及腹部肿块的克罗恩病患者，通常避免使用类固醇疗法，因为担心如果肿块被证实含有脓肿，会导致感染扩散。在本研究中，24例患有可触及腹部肿块的克罗恩病患者接受了大剂量类固醇治疗。其中15例肿块完全消退，另外9例肿块大小至少缩小了50%。24例患者中有14例最终因克罗恩病活动持续或复发（无论有无腹部肿块）而需要进行手术切除，但所有手术均为择期进行。在平均40个月的随访期内，至少有8例患者从未需要进行手术切除。在13例患者中，后来证实肿块实际含有脓肿腔。手术组和非手术组均未出现类固醇治疗相关的并发症。临床医生在有指征的情况下，不应惧怕使用大剂量促肾上腺皮质激素/皮质类固醇来治疗伴有腹部肿块的重度克罗恩病，因为无论是否存在脓肿腔，这种治疗都是安全有效的。
