Yamazaki Y, Ribeiro M B, Sachar D B, Aufses A H, Greenstein A J
Department of Surgery, Mount Sinai School of Medicine, City University of New York, NY.
Am J Gastroenterol. 1991 Jul;86(7):882-5.
One hundred thirty-two of 980 patients (13.5%) with Crohn's disease (CD) involving the colon, admitted to The Mount Sinai Hospital between 1959 and 1985, developed 175 colonic strictures. Thirty-three patients developed more than one stricture. The frequency was twice as great in colitis (19%) as in ileocolitis (11%). Ten malignant strictures were identified in nine patients (three ileocolitis, six colitis). One of these patients had three strictures (two malignant, and one benign), and two had two strictures (one malignant and one benign). The frequency of cancer in patients with stricture (6.8%) was higher than in those without stricture (0.7%, six of 848, p less than 0.001). There were no differences in clinical symptoms between patients with benign and malignant stricture. Seventeen of 165 benign strictures (10.3%) were long, extending over more than one anatomical segment of colon, but all 10 malignant strictures were short (p less than 0.0001). The age at the diagnosis of stricture was higher in the nine patients with malignant stricture than in the 123 patients with benign stricture (mean age 57.2 vs. 41.4 yr, respectively, p less than 0.01). The proportion of strictures that were malignant increased with duration of disease from 3.3% with less than 20 yr of CD, to 11% with CD of 20 yr or more. All nine patients with malignant stricture were treated surgically, and four of the nine died of colon cancer during a mean follow-up of 4.3 yr. Prognosis was worse in six other nonstricture cancers in this series, with five colon cancer deaths during mean follow-up of 1.6 yr. In view of the high rate of malignancy, 6.8% in this series, colonoscopy with biopsy is essential in Crohn's disease patients with colonic strictures, and surgery must be considered when a stricture cannot be fully assessed during colonoscopy.
1959年至1985年间，980例患有累及结肠的克罗恩病（CD）患者中有132例（13.5%）出现了175处结肠狭窄。33例患者出现了不止一处狭窄。结肠炎患者中狭窄的发生率（19%）是回结肠型患者（11%）的两倍。在9例患者（3例回结肠型，6例结肠型）中发现了10处恶性狭窄。其中1例患者有3处狭窄（2处恶性，1处良性），2例患者有2处狭窄（1处恶性，1处良性）。有狭窄的患者中癌症的发生率（6.8%）高于无狭窄的患者（0.7%，848例中有6例，p<0.001）。良性和恶性狭窄患者的临床症状没有差异。165处良性狭窄中有17处（10.3%）较长，延伸超过结肠的一个以上解剖节段，但所有10处恶性狭窄均较短（p<0.0001）。9例恶性狭窄患者诊断狭窄时的年龄高于123例良性狭窄患者（平均年龄分别为57.2岁和41.4岁，p<0.01）。恶性狭窄的比例随着疾病持续时间从CD病程小于20年时的3.3%增加到CD病程20年或更长时的11%。所有9例恶性狭窄患者均接受了手术治疗，9例中有4例在平均4.3年的随访期间死于结肠癌。该系列中其他6例非狭窄性癌症的预后更差，在平均1.6年的随访期间有5例结肠癌死亡。鉴于本系列中6.8%的恶性率较高，对于患有结肠狭窄的克罗恩病患者，结肠镜检查及活检至关重要，当结肠镜检查无法完全评估狭窄时必须考虑手术治疗。
