Section of Minimally Invasive Surgery and The Bariatric and Metabolic Institute, Cleveland Clinic Florida, Weston, Fla. 33331, USA.
Dig Dis. 2009;27(4):560-4. doi: 10.1159/000233298. Epub 2009 Nov 4.
The goal of the surgical management of Crohn's disease is to improve quality of life. Surgical management is generally reserved for patients who developed complications of the disease or who are unresponsive to or develop complications from aggressive medical therapy. Friable mesentery, inflammatory phlegmons, fistulas, abscesses, and adhesions from previous surgeries pose a surgical challenge to the laparoscopic approach. The laparoscopic approach to terminal ileal Crohn's disease is feasible and safe even in cases complicated by fistulas with previous abdominal surgery or recurrent disease. This approach is associated with an increased operative time compared to laparotomy, however, offers significant advantages over open ileocolic resection in terms of pulmonary function, length of hospital stay, duration of postoperative ileus, cosmesis, postoperative small bowel obstruction, and early postoperative complications. Laparoscopy is also associated with decreased overall hospitalization costs and improved patient satisfaction. Therefore, the laparoscopic approach for patients with Crohn's disease should be considered as the preferred operative approach.
克罗恩病的手术治疗目标是提高生活质量。手术治疗通常保留给出现疾病并发症或对积极的药物治疗无反应或出现并发症的患者。脆弱的肠系膜、炎症性痛肿、瘘管、脓肿和先前手术引起的粘连对腹腔镜方法构成手术挑战。即使在有先前腹部手术或复发性疾病合并瘘管的情况下，腹腔镜治疗末端回肠克罗恩病也是可行和安全的。与剖腹手术相比，这种方法的手术时间更长，但与开腹回结肠切除术相比，在肺功能、住院时间、术后肠梗阻持续时间、美容效果、术后小肠梗阻和早期术后并发症方面具有显著优势。腹腔镜检查还与总住院费用降低和提高患者满意度相关。因此，对于克罗恩病患者，腹腔镜方法应被视为首选的手术方法。
