Mühe E, Gall F P, Hager T, Angermann B, Söhnlein B, Schier F, Hermanek P
Dtsch Med Wochenschr. 1981 Feb 6;106(6):165-70. doi: 10.1055/s-2008-1070278.
Operative mortality after intestinal resection in 155 patients with Crohn's disease was 8.4%. In 12 of 13 the cause of death was septic complications, most of them related to prolonged pre-operative cortisone medication. Follow-up examination was possible in 90% of all discharges. Five-year recurrence rate was 37.6%. Recurrence was not prevented by long-term drug treatment. Purely macroscopic assessment of the resection margins would have led to excision within diseased gut: for this reason frozen sections are recommended before the anastomosis is made. Primary death-rate in 30 cases of colectomy with primary ileorectostomy was 3%. In three patients the rectum had to be excised, while in one the anastomosis had to be taken down because of recurrence. The failure rate was thus only 11%. If rectoscopy, stepwise biopsy and intra-operative frozen section indicate a normal rectum it is recommended that ileorectostomy be done rather than diversion ileostomy with occlusion of the rectum or even proctocolectomy.
155例克罗恩病患者行肠道切除术后的手术死亡率为8.4%。13例死亡患者中有12例的死因是感染性并发症，其中大多数与术前长期使用皮质激素药物有关。90%的出院患者接受了随访检查。五年复发率为37.6%。长期药物治疗并不能预防复发。仅通过肉眼对切除边缘进行评估会导致在病变肠段内进行切除：因此，建议在进行吻合术前做冰冻切片检查。30例行一期回肠直肠吻合术的结肠切除术患者的原发性死亡率为3%。3例患者不得不切除直肠，1例患者因复发不得不拆除吻合口。因此失败率仅为11%。如果直肠镜检查、逐步活检和术中冰冻切片显示直肠正常，建议行回肠直肠吻合术，而不是行直肠闭塞的转流性回肠造口术甚至全直肠结肠切除术。
