Moon Joon Suk, Lee Jong Lyul, Yu Chang Sik, Lim Seok-Byung, Park In Ja, Yoon Yong Sik, Kim Chan Wook, Yang Suk-Kyun, Ye Byong Duk, Park Sang Hyoung, Alsaleem Hassan Abdullah, Kim Jin Cheon
Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Ann Coloproctol. 2020 Aug;36(4):243-248. doi: 10.3393/ac.2019.10.16.1. Epub 2020 Mar 16.
Upper gastrointestinal (GI) tract involvement in Crohn disease (CD) is rare and effectiveness of surgical treatment is limited. The aim of this study was to evaluate characteristics and surgical outcomes of upper GI CD.
Medical records of 811 patients who underwent intestinal surgery for CD between January 2006 and December 2015 at a single institution were reviewed. Upper GI CD was defined by involvement of the stomach to the fourth portion of duodenum, with or without concomitant small/large bowel CD involvement according to a modification of the Montreal classification.
We identified 24 patients (21 males, 3 females) who underwent surgery for upper GI CD. The mean age at diagnosis was 27 ± 12 years, the mean age at surgery was 33 ± 11 years, and the mean duration of CD was 73.6 ± 56.6 months. Fifteen patients (62.5%) had history of previous perianal surgery. Ten patients (41.7%) had duodenal or gastric stricture and 14 patients (58.3%) had penetrating fistula; patients with fistula were significantly more likely to develop complications (57.1% vs. 20.0%, P = 0.035). One patient with stricture had surgical recurrence. In seven patients with fistula, fistula was related to previous anastomosis. Patients with fistula had significantly longer hospital stays than those with stricture (16 days vs. 11 days, P = 0.01).
Upper GI CD is rare among CD types (2.96%). In patients with upper GI CD, penetrating fistula was associated with longer hospital stay and more complications.
克罗恩病（CD）累及上消化道（GI）较为罕见，手术治疗效果有限。本研究旨在评估上消化道CD的特征及手术疗效。
回顾了2006年1月至2015年12月在单一机构因CD接受肠道手术的811例患者的病历。根据蒙特利尔分类法的修订版，上消化道CD定义为胃至十二指肠第四部分受累，无论是否伴有小肠/大肠CD受累。
我们确定了24例因上消化道CD接受手术的患者（21例男性，3例女性）。诊断时的平均年龄为27±12岁，手术时的平均年龄为33±11岁，CD的平均病程为73.6±56.6个月。15例患者（62.5%）有肛周手术史。10例患者（41.7%）有十二指肠或胃狭窄，14例患者（58.3%）有穿透性瘘管；有瘘管的患者发生并发症的可能性显著更高（57.1%对20.0%，P = 0.035）。1例狭窄患者出现手术复发。7例有瘘管的患者中，瘘管与既往吻合术有关。有瘘管的患者住院时间明显长于有狭窄的患者（16天对11天，P = 0.01）。
上消化道CD在CD类型中较为罕见（2.96%）。在上消化道CD患者中，穿透性瘘管与更长的住院时间和更多并发症相关。
