Roberts P L, Schoetz D J, Pricolo R, Veidenheimer M C
Department of Colon and Rectal Surgery, Lahey Clinic Medical Center, Burlington, Massachusetts 01805.
Dis Colon Rectum. 1990 Jun;33(6):458-62. doi: 10.1007/BF02052138.
The authors retrospectively reviewed the records of 50 patients whose initial diagnosis of Crohn's disease was made after the age of 50 years on the basis of strict histopathologic criteria. Progress of the 32 women and 18 men with a median age of 60 years (range, 50 to 78 years) was followed for a median of 95.5 months (range, 81.1 to 236.6 months). The most common presenting signs and symptoms were abdominal pain (82 percent), diarrhea (70 percent), weight loss (56 percent), bleeding from the gastrointestinal tract (26 percent), abdominal mass (16 percent), and fistula (14 percent). Initial operations performed were ileocolic resection (38 percent), proctocolectomy (16 percent), small bowel resection (10 percent), colostomy (2 percent), and a variety of segmental resections of the colon (34 percent). The overall recurrence rate of disease in patients in whom all obvious disease was resected, based on distribution of disease, was 80 percent (ileocolitis), 38 percent (ileitis), and 35 percent (colitis). Crohn's disease more often affects the distal gastrointestinal tract in older age groups. After resection, however, the clinical course is similar to that of the younger population. The high recurrence rate of Crohn's colitis is probably a result of the large number of initial segmental resections.
作者回顾性分析了50例初诊年龄在50岁及以上、符合严格组织病理学标准的克罗恩病患者的病历。对32例女性和18例男性患者进行随访，他们的年龄中位数为60岁（范围为50至78岁），随访时间中位数为95.5个月（范围为81.1至236.6个月）。最常见的症状和体征为腹痛（82%）、腹泻（70%）、体重减轻（56%）、胃肠道出血（26%）、腹部肿块（16%）和瘘管（14%）。初次手术方式包括回结肠切除术（38%）、全直肠结肠切除术（16%）、小肠切除术（10%）、结肠造口术（2%）以及各种结肠节段切除术（34%）。根据疾病分布情况，所有明显病变均被切除的患者中，疾病的总体复发率为：回结肠型肠炎80%、小肠型肠炎38%、结肠型肠炎35%。在老年人群中，克罗恩病更常累及远段胃肠道。然而，手术后的临床病程与年轻人群相似。克罗恩病性结肠炎的高复发率可能是由于大量初次进行的节段性切除术所致。
