Czymek Ralf, Limmer Stefan, Kleemann Markus, Hildebrand Philipp, Schmidt Andreas, Jungbluth Thomas, Roblick Uwe, Kujath Peter, Bruch Hans-Peter
Department of Surgery, University of Luebeck Medical School, Ratzeburger Allee 160, Lübeck, Germany.
Langenbecks Arch Surg. 2009 May;394(3):517-27. doi: 10.1007/s00423-008-0431-2. Epub 2008 Nov 11.
In the past, women with Crohn's disease (CD) as a risk factor in pregnancy were discouraged from becoming pregnant. Today, by contrast, gestation is medically acceptable in these patients despite several severe complications.
We present the course of five female patients with CD requiring surgery during pregnancy and giving birth at our institution between 1998 and 2008. These cases as well as our treatment recommendations for patients wishing to have children and our approaches to the management of complications during pregnancy are discussed in the light of the literature.
Three of five women had a preterm delivery (26 to 31 weeks' gestation) with a decreased neonatal weight. Generally, the diagnosis of CD is often delayed and diagnostic errors (four of five women) are not uncommon. The symptoms vary widely and include those typical of pregnancy. Three patients had to have a cesarean and only two patients were able to deliver vaginally. Especially in pregnant patients, the course of the disease is highly variable and difficult to predict. Our experience suggests that patients should be advised to conceive during remission. Indications for surgery in pregnant patients are the same as for nonpregnant women and include perforation, obstruction, hemorrhage, and abscess. The advantages of endoscopic surgery also apply to pregnant patients with acute manifestations. A stoma is not a contraindication to vaginal delivery.
过去，患有克罗恩病（CD）且将其作为妊娠风险因素的女性被劝阻不要怀孕。相比之下，如今尽管存在一些严重并发症，但这些患者的妊娠在医学上是可以接受的。
我们介绍了1998年至2008年间在我们机构妊娠期间需要手术并分娩的5例CD女性患者的病程。结合文献讨论了这些病例以及我们对希望生育的患者的治疗建议和我们在妊娠期间处理并发症的方法。
5名女性中有3名早产（妊娠26至31周），新生儿体重减轻。一般来说，CD的诊断常常延迟，诊断错误（5名女性中有4名）并不罕见。症状差异很大，包括妊娠典型症状。3名患者不得不进行剖宫产，只有2名患者能够经阴道分娩。特别是在孕妇中，疾病的病程变化很大且难以预测。我们的经验表明，应建议患者在病情缓解期受孕。孕妇手术指征与非孕妇相同，包括穿孔、梗阻、出血和脓肿。内镜手术的优点也适用于有急性表现的孕妇。造口术不是经阴道分娩的禁忌证。
