Glotzer D J
World J Surg. 1980;4(2):173-82. doi: 10.1007/BF02393571.
There has been great controversy about the proper role of operation in the management of colonic Crohn's disease because of disagreement about the frequency of recurrence. Since, in our retrospective studies, the majority of patients with colonic Crohn's disease had a previous diagnosis of ulcerative colitis, accurate determination of the recurrence rate in colonic Crohn's disease requires review of all patients with colonic inflammatory bowel disease in order to define the population at risk. Using objective means for diagnosis and for the assessment of outcome, we have found that recurrent disease after ileostomy and colectomy occurred in a minority (approximately 16%) of the patients. Both Crohn's colitis and ulcerative colitis followed a generally favorable postoperative course after this procedure, since even those patients who developed recurrent disease usually were rehabilitated by one or more revisions of the ileostomy. We believe that needed operations should not be avoided solely because of a diagnosis of colonic Crohn's disease, since the high recurrence rates and poor prognoses reported in many studies are based on falsely low numbers of those at risk.
由于对复发频率存在分歧，手术在结肠克罗恩病治疗中的恰当作用一直存在很大争议。鉴于在我们的回顾性研究中，大多数结肠克罗恩病患者之前被诊断为溃疡性结肠炎，准确确定结肠克罗恩病的复发率需要对所有结肠炎性肠病患者进行复查，以便确定高危人群。通过使用客观的诊断方法和评估结果，我们发现回肠造口术和结肠切除术后复发性疾病发生在少数（约16%）患者中。克罗恩结肠炎和溃疡性结肠炎在此手术后通常都有良好的术后病程，因为即使那些出现复发性疾病的患者通常也通过一次或多次回肠造口术修复而康复。我们认为，不应仅仅因为诊断为结肠克罗恩病而避免进行必要的手术，因为许多研究报告的高复发率和不良预后是基于错误的低危人数。
