Korelitz B I, Cheskin L J, Sohn N, Sommers S C
J Clin Gastroenterol. 1985 Feb;7(1):37-43. doi: 10.1097/00004836-198502000-00005.
Diverting the fecal stream has been considered to benefit the course of Crohn's disease. Clinical signs and symptoms have not, however, been distinguished previously from the objective inflammatory changes in the distal segment. We reviewed the course of 16 consecutive patients with Crohn's disease in whom sigmoidoscopy showed normal mucosa at the time of diversion and who underwent an ileostomy or colostomy, the rectal segment being left in place. As early as 3 months after diversion, all 16 patients showed progressive friability, ulceration, and exudation in the retained rectum. Stricture occurred in four and lead to abdominoperineal resection in three. Four of eight patients with only moderate inflammation on sigmoidoscopy underwent reanastomosis which was followed by a return to a normal-appearing rectal mucosa. The rectal segment inflammed after diversion rarely shows the histological characteristics of Crohn's disease when resected. This leads us to suspect that the disorder of nonspecific "diversion colitis" might account for this phenomenon entirely, or at least it may accelerate the Crohn's disease process. Continuity of the intestinal tract should be maintained in the course of Crohn's disease surgery if feasible. If a diversion is clinically warranted, reanastomosis should be considered as early as possible despite progressive inflammation of the rectal mucosa.
改道粪便流被认为有利于克罗恩病的病程。然而，临床体征和症状此前并未与远端节段的客观炎症变化区分开来。我们回顾了16例连续性克罗恩病患者的病程，这些患者在改道时乙状结肠镜检查显示黏膜正常，且接受了回肠造口术或结肠造口术，直肠段保留原位。早在改道后3个月，所有16例患者的保留直肠均出现进行性脆弱、溃疡和渗出。4例出现狭窄，其中3例导致腹会阴切除术。8例乙状结肠镜检查仅显示中度炎症的患者中有4例接受了重新吻合术，随后直肠黏膜恢复正常外观。改道后发炎的直肠段切除时很少显示克罗恩病的组织学特征。这使我们怀疑非特异性“改道性结肠炎”紊乱可能完全解释了这一现象，或者至少它可能加速了克罗恩病的进程。如果可行，在克罗恩病手术过程中应保持肠道的连续性。如果临床上有改道的必要，尽管直肠黏膜有进行性炎症，也应尽早考虑重新吻合术。
