Platell C, Mackay J, Collopy B, Fink R, Ryan P, Woods R
Department of Colon and Rectal Surgery, St Vincent's Hospital, Fitzroy, Victoria, Australia.
Aust N Z J Surg. 1995 Aug;65(8):570-5. doi: 10.1111/j.1445-2197.1995.tb01697.x.
This study reviewed a series of patients with Crohn's disease managed by surgeons of the Department of Colon and Rectal Surgery, St Vincent's Hospital, Melbourne, since 1978. There were 306 patients: 171 males and 135 females. The mean age at diagnosis was 33.4 years (ranger 11-93). The distribution of the disease was small bowel 32.3%, small bowel and colon 26.5%, colon 39.9%, and anal disease alone 1.6%. A total of 416 abdominal operations were performed on 204 patients. The commonest indications for surgery were failed medical therapy (21.9%), small bowel obstruction (15.9%), enteric fistula (10.1%), and intra-abdominal abscess (10.1%). The most frequently performed procedures were ileocolic resection with anastomosis (28.8%), small bowel resection (9.4%), and total colectomy and ileostomy (7.0%). Postoperative complications included anastomotic leaks in 4.0%, intra-abdominal abscess formation in 3.6%, and enterocutaneous fistulae developed in 6%. Three patients died during the review period. During follow up (mean 84.4), 30% of patients developed recurrence requiring further surgery at a mean of 72.7 months postoperatively. The most frequent site for a recurrence was the pre-anastomotic terminal ileum (61.7%). In conclusion, the majority of patients with Crohn's disease will require resectional surgery at some stage. This can be performed with a low mortality and morbidity, and a recurrence rate of around 5% per year.
本研究回顾了自1978年以来由墨尔本圣文森特医院结直肠外科医生管理的一系列克罗恩病患者。共有306例患者，其中男性171例，女性135例。诊断时的平均年龄为33.4岁（范围11 - 93岁）。疾病分布情况为：小肠32.3%，小肠和结肠26.5%，结肠39.9%，单纯肛门疾病1.6%。对204例患者共进行了416次腹部手术。最常见的手术指征是药物治疗失败（21.9%）、小肠梗阻（15.9%）、肠瘘（10.1%）和腹腔内脓肿（10.1%）。最常施行的手术是回结肠切除吻合术（28.8%）、小肠切除术（9.4%）和全结肠切除回肠造口术（7.0%）。术后并发症包括吻合口漏4.0%，腹腔内脓肿形成3.6%，肠皮肤瘘形成6%。在回顾期间有3例患者死亡。在随访期间（平均84.4个月），30%的患者出现复发，平均在术后72.7个月需要再次手术。复发最常见的部位是吻合口前的回肠末端（61.7%）。总之，大多数克罗恩病患者在某个阶段需要进行切除手术。手术死亡率和发病率较低，每年复发率约为5%。
