Bezzi M, Pastore P, Bolignari S, Eleuteri E, Coppola M, Zoras O, Illuminati G, Angelini L
Cattedra di Chirurgia Sperimentale VIII, Università La Sapienza, Roma.
Ital J Surg Sci. 1988;18(2):131-5.
Radiologic and endoscopic demonstration of ileosigmoid fistulas is difficult: some are discovered only at operation. In these cases the surgeon is faced with the decision of either to remove "en bloc " the involved bowel or to simply close the sigmoid defect. Twelve patients with Crohn's disease complicated by ileosigmoid fistulas were operated: 7 by ileal and/or colonic resection and simple closure of the sigmoid fistula, 4 by double resection and 1 by total colectomy. Stomas were performed in 2. The review of this experience demonstrated that conservative surgery is effective and safe in most cases. Local extended resection should be reserved to cases where secondary involvement of a rather long segment of the intestine is present or where the sigmoid and rectum are primarily involved by active severe Crohn's disease. In these cases, a protective stoma may be considered.
有些仅在手术时才被发现。在这些情况下，外科医生面临着是“整块”切除受累肠段还是简单闭合乙状结肠缺损的决定。12例克罗恩病合并回肠乙状结肠瘘的患者接受了手术：7例行回肠和/或结肠切除并简单闭合乙状结肠瘘，4例行双切除，1例行全结肠切除。2例行造口术。对该经验的回顾表明，在大多数情况下，保守手术是有效且安全的。局部扩大切除术应保留用于存在较长肠段继发性受累或乙状结肠和直肠主要受活动性重度克罗恩病累及的病例。在这些情况下，可以考虑做保护性造口。
