Department of Surgery, University Hospital Limerick, Limerick, Ireland.
University of Limerick Graduate Entry Medical School and Centre for Interventions in Infection, Inflammation & Immunity, Limerick, Ireland.
J Dig Dis. 2020 Jun;21(6):355-359. doi: 10.1111/1751-2980.12880. Epub 2020 Jun 18.
Fibroblast infiltration and collagen deposition result in structural changes in the bowel wall, and lead to strictures in intestinal inflammatory disease. While strictures can also occur in other contexts, such as malignancy, this review focuses on the surgical treatment of stricture secondary to inflammatory bowel disease. Distinguishing between predominantly inflammation vs established fibrosis as the cause of a stricture can be challenging. While inflammatory strictures may be responsive to medication, predominantly fibrotic strictures usually need surgical intervention. Both endoluminal and extraluminal approaches are described in this review. Endoscopic dilatation of strictures is suitable for short-segment isolated small bowel strictures. Other options are to divide the stricture surgically but preserve the length, performing a strictureplasty or resecting the strictured segment. The mesentery is increasingly recognized as playing a role in stricture recurrence. In a relapsing-remitting disease such as Crohn's disease, the preservation of intestinal length is essential and balance is needed between this and a complete resection to reduce the risk of recurrence. Pre- and postoperative involvement of the multidisciplinary team is essential to improve outcomes in this challenging clinical scenario.
成纤维细胞浸润和胶原沉积导致肠壁结构发生变化，并导致肠道炎症性疾病发生狭窄。虽然狭窄也可能发生在其他情况下，如恶性肿瘤，但本综述重点关注炎症性肠病继发狭窄的手术治疗。区分狭窄主要是炎症还是已形成的纤维化作为病因具有挑战性。虽然炎症性狭窄可能对药物治疗有反应，但主要为纤维化的狭窄通常需要手术干预。本综述描述了腔内和腔外方法。内镜下扩张狭窄适用于短节段孤立性小肠狭窄。其他选择是手术分割狭窄，但保留长度，进行狭窄成形术或切除狭窄段。肠系膜越来越被认为在狭窄复发中起作用。在克罗恩病等复发性疾病中，保持肠道长度至关重要，需要在这与完全切除之间取得平衡，以降低复发风险。多学科团队的术前和术后参与对于改善这种具有挑战性的临床情况下的结果至关重要。
