Ribeiro M B, Greenstein A J, Heimann T M, Yamazaki Y, Aufses A H
Department of Surgery, Mount Sinai School of Medicine, City University of New York.
Surg Gynecol Obstet. 1991 Nov;173(5):343-9.
Nineteen patients admitted to The Mount Sinai Hospital with Crohn's disease between 1960 and 1989 had 20 adenocarcinomas of the small intestine. Sixteen patients had regional enteritis and three, ileocolitis. There were 15 males and four females. Carcinomas occurred in association with fistulas (four patients), fistulous tracts (three patients), excluded bowel (five patients/six cancers) and multiple strictures (three patients). None of the patients in our study had cancer develop in the first decade of Crohn's disease, and 11 had carcinoma in the third decade. As cancers occurred in three patients with multiple strictures admitted for strictureplasty, we recommend that all strictures be widely opened and carefully examined prior to strictureplasty, with frozen section biopsies of all suspicious areas. The possibility of small intestinal Crohn's carcinoma should be suspected in patients with long-standing disease, with or without excluded bowel, who present with sudden change in symptoms, especially after a lengthy quiescent period. Cancer should also be considered in patients in whom complete obstruction fails to resolve with adequate decompression and in those with multiple strictures.
1960年至1989年间，19名因克罗恩病入住西奈山医院的患者发生了20例小肠腺癌。16例为局限性肠炎，3例为回结肠型肠炎。男性15例，女性4例。腺癌与瘘管（4例患者）、瘘管通道（3例患者）、旷置肠段（5例患者/6处癌症）及多处狭窄（3例患者）相关。本研究中，无患者在克罗恩病的第一个十年内发生癌症，11例患者在第三个十年发生癌症。由于3例因狭窄成形术入院的多处狭窄患者发生了癌症，我们建议在狭窄成形术前广泛切开所有狭窄并仔细检查，对所有可疑区域进行冰冻切片活检。对于患有长期疾病、有或无旷置肠段、症状突然改变（尤其是在长期静止期后）的患者，应怀疑小肠克罗恩癌的可能性。对于经充分减压后完全性肠梗阻仍未缓解的患者以及有多发性狭窄的患者，也应考虑癌症的可能。
