Weston L A, Roberts P L, Schoetz D J, Coller J A, Murray J J, Rusin L C
Lahey Hitchcock Medical Center, Burlington, Massachusetts, USA.
Dis Colon Rectum. 1996 Aug;39(8):841-6. doi: 10.1007/BF02053980.
Traditional therapy for patients with terminal ileitis found at laparotomy for appendicitis has been to perform appendectomy when the cecum is normal and to leave the diseased ileum in place.
To determine the role of ileocolic resection in the setting of acute ileitis, records of 1,421 patients with Crohn's disease seen from 1986 to 1994 were retrospectively reviewed.
Crohn's disease was found at laparotomy for presumed appendicitis in 36 patients (2.5 percent). Ten patients underwent ileocolic resection, 23 had appendectomy, and 3 had exploratory laparotomy alone. One patient whose appendix was removed also had ileocecal bypass. Of the 36 patients, 20 were women and 16 were men. Mean age at operation was 24 (range, 11-61) years, and mean follow-up time was 14 (range, 0.1-49) years. After initial ileocolic resection, five patients (50 percent) required no further resection, with a mean follow-up time of 12.4 (range, 4-19) years. None required more than three ileocolic resections, with a mean follow-up time of 18.1 (range, 4-49) years. Of 26 patients treated traditionally, 24 (92 percent) required ileocolic resection for intractability or complications of Crohn's disease. Thirty-eight percent required resection within one year and 65 percent within three years (intractability, 8; obstruction, 3; fistula, 4; and perforation, 2). Of 24 patients who subsequently underwent resection, only 6 (25 percent) required further small-bowel resection for Crohn's disease, with a mean follow-up time of 13 (range, 0.1-34) years.
The majority of patients found to have Crohn's disease at laparotomy for appendicitis required early ileocolic resection. Therefore, the traditional dictum of nonoperative therapy for these patients may not be in their best long-term interest and merits re-evaluation.
对于在阑尾炎剖腹手术中发现的终末段回肠炎患者，传统治疗方法是在盲肠正常时行阑尾切除术，并保留病变的回肠。
为确定回结肠切除术在急性回肠炎治疗中的作用，对1986年至1994年间诊治的1421例克罗恩病患者的记录进行回顾性分析。
在因疑似阑尾炎行剖腹手术的患者中，发现36例（2.5%）患有克罗恩病。10例行回结肠切除术，23例行阑尾切除术，3例仅行剖腹探查术。1例切除阑尾的患者还行了回盲部旁路术。36例患者中，20例为女性，16例为男性。手术时的平均年龄为24岁（范围11 - 61岁），平均随访时间为14年（范围0.1 - 49年）。初次回结肠切除术后，5例患者（50%）无需进一步切除，平均随访时间为12.4年（范围4 - 19年）。无人需要超过三次回结肠切除术，平均随访时间为18.1年（范围4 - 49年）。在26例接受传统治疗的患者中，24例（92%）因克罗恩病难以控制或出现并发症而需要行回结肠切除术。38%的患者在1年内需要切除，65%在3年内需要切除（难以控制8例，梗阻3例，瘘管4例，穿孔2例）。在随后接受切除术的24例患者中，仅6例（25%）因克罗恩病需要进一步行小肠切除术，平均随访时间为13年（范围0.1 - 34年）。
大多数在阑尾炎剖腹手术中发现患有克罗恩病的患者需要早期行回结肠切除术。因此，对这些患者非手术治疗的传统原则可能不符合他们的最佳长期利益，值得重新评估。
