Morales V, Enríquez J M, Camuñas J, Fernández J, Carda P, Devesa M, Moreira V
Rev Esp Enferm Apar Dig. 1989 Aug;76(2):115-9.
The treatment of patients with Crohn's disease (CD) presenting intestinal fistulas is debated. A retrospective analysis was made of the treatment of 26 patients with Crohn's disease who had a total of 37 fistulas: 28 internal and 9 external. In 19 patients the fistulas were single and in 7 multiple; in most patients the fistula originated on the terminal ileum. Crohn's disease was ileal in 10 patients, ileocolonic in 15 and exclusively colonic in 1, and the evolution of the disease from the onset of symptoms to the appearance of the fistula was a mean of 5.8 years. The diagnosis, except for two patients in whom it was an operative finding, was based on the clinical examination and radiology studies. All the patients, except for four with asymptomatic internal fistulas, underwent medical treatment as needed. Six patients required only medical treatment, and the rest, 16, received medical and surgical treatment. Surgical treatment consisted basically of resection of the intestinal segment affected by the fistula, with or without anastomosis. The operative mortality was 0% and the morbidity was 25%, the most frequent complication being infection of the surgical wound. All the patients with external fistulas required surgical treatment. In every case the fistula was single. The treatment of internal fistulas in conditioned by the symptoms the response to medical treatment and the presence or not of associated pathology. Asymptomatic patients or those who responded to medical treatment had single fistulas.
克罗恩病（CD）合并肠瘘患者的治疗存在争议。对26例患有克罗恩病且共有37处瘘管的患者的治疗情况进行了回顾性分析：其中28处为内瘘，9处为外瘘。19例患者为单发瘘管，7例为多发瘘管；大多数患者的瘘管起源于回肠末端。10例患者的克罗恩病累及回肠，15例累及回结肠，1例仅累及结肠，从症状出现到瘘管出现，疾病的平均进展时间为5.8年。除2例患者通过手术发现外，其余患者的诊断均基于临床检查和影像学研究。除4例无症状内瘘患者外，所有患者均根据需要接受了药物治疗。6例患者仅需药物治疗，其余16例接受了药物和手术治疗。手术治疗主要包括切除受瘘管影响的肠段，可进行或不进行吻合。手术死亡率为0%，发病率为25%，最常见的并发症是手术伤口感染。所有外瘘患者均需手术治疗。每例患者均为单发瘘管。内瘘的治疗取决于症状、对药物治疗的反应以及是否存在相关病变。无症状患者或对药物治疗有反应的患者为单发瘘管。
