Takahashi Ken-ichi, Funayama Yuji, Fukushima Kouhei, Shibata Chikashi, Ogawa Hitoshi, Kumagai Eiko, Sasaki Iwao
Department of Surgery, Division of Gastrointestinal and Colorectal Surgery, Tohoku University Graduate School of Medicine, and Wound, Ostomy, and Continence Center, Tohoku University Hospital, Sendai, 980-8574, Japan.
Int J Colorectal Dis. 2007 Mar;22(3):313-8. doi: 10.1007/s00384-006-0148-z. Epub 2006 May 20.
Enterostomy is often undergone by patients with Crohn's disease (CD) due to severe anorectal lesions such as rectovaginal fistula (RVF). Reports of successful pregnancy and delivery, which are important determinants of quality of life for female CD patients with stoma, are limited. Thus, we investigated problems associated with pregnancy and delivery in female CD patients at our hospital.
Between 1985 and 2003, five female CD patients with enterostoma carried seven pregnancies and delivered eight babies in our hospital. For this study, we investigated CD activity, fetal growth, stoma complications, and the outcome of delivery in these seven pregnancies.
Among the five patients, four underwent loop ileostomy and one loop sigmoidostomy for treatment of RVF or severe stricture of the rectum or sigmoid colon. Except for one case, no fertility treatment was done. During pregnancy, a flare-up was observed in one patient and was successfully treated with corticosteroids. Although home enteral or parenteral nutrition was required in two cases, fetal growth was within the normal range in all pregnancies. Preterm delivery occurred in one case with a twin pregnancy. The mean diameter of stoma increased during pregnancy (p<0.01), and a mucosal laceration of stoma by the edge of an ostomy appliance occurred in one case. All deliveries were safe, with six cesarean sections and one transvaginal delivery. After each delivery, the stoma returned to pre-pregnancy size.
Pregnancy and delivery in CD patients with stoma is safe and should be encouraged. However, special attention to disease activity, nutritional support, and stoma-related complications is recommended.
克罗恩病（CD）患者常因严重的肛肠病变如直肠阴道瘘（RVF）而接受肠造口术。对于有造口的女性CD患者而言，成功妊娠和分娩是生活质量的重要决定因素，但其相关报道有限。因此，我们对我院女性CD患者妊娠和分娩相关问题进行了调查。
1985年至2003年间，我院5例有肠造口的女性CD患者共妊娠7次，分娩8名婴儿。本研究中，我们调查了这7次妊娠中的CD活动情况、胎儿生长情况、造口并发症及分娩结局。
5例患者中，4例行回肠袢式造口术，1例行乙状结肠袢式造口术，以治疗RVF或直肠或乙状结肠严重狭窄。除1例患者外，均未进行生育治疗。妊娠期间，1例患者病情复发，经皮质类固醇治疗成功。虽然2例患者需要家庭肠内或肠外营养，但所有妊娠的胎儿生长均在正常范围内。1例双胎妊娠患者发生早产。妊娠期间造口平均直径增大（p<0.01），1例患者造口黏膜被造口器具边缘划破。所有分娩均安全，其中6例剖宫产，1例经阴道分娩。每次分娩后，造口恢复至妊娠前大小。
有造口的CD患者妊娠和分娩是安全的，应予以鼓励。然而，建议特别关注疾病活动、营养支持及造口相关并发症。
