Glotzer D J
Beth Israel Hospital, Boston, Massachusetts, USA.
Gastroenterol Clin North Am. 1995 Sep;24(3):577-96.
Recurrence of disease after restorative operation for Crohn's disease is the rule rather than the exception. In fact, studies using colonoscopic surveillance show that minute recurrent lesions appear early on after operation in the majority of patients. Radical extirpation of disease does not reduce the rate of recurrence but only predisposes to the development of short bowel syndrome. Unfortunately, although in preliminary studies some prophylactic drug regimens seem to delay recurrence, no agent has been shown to be sufficiently potent to change this basic picture. Cure is possible in many cases of predominately colonic disease, but this comes at the expense of a permanent ileostomy. Despite these gloomy statistics, 70% or more of patients require one or more operations during their course. This conundrum is managed by using conservative indications for operation and by bowel-conserving operative procedures. Thus employed and carried out, operation has a favorable impact on the quality of life of these patients. Similarly conservative surgical treatment of the perineal complications, which are frequent and devastating, can be of enormous benefit.
克罗恩病修复手术后疾病复发是普遍现象而非例外。事实上，使用结肠镜监测的研究表明，大多数患者术后早期就会出现微小的复发病变。彻底切除病灶并不能降低复发率，反而会增加短肠综合征的发生风险。不幸的是，尽管在初步研究中一些预防用药方案似乎能延迟复发，但尚无药物被证明有足够效力改变这一基本情况。许多以结肠病变为主的病例有可能治愈，但这是以永久性回肠造口术为代价的。尽管有这些令人沮丧的数据，但70%或更多的患者在病程中需要进行一次或多次手术。通过采用保守的手术指征和保留肠管的手术方法来解决这一难题。如此应用和实施手术，对这些患者的生活质量有积极影响。同样，对常见且严重的会阴并发症进行保守手术治疗也可能带来巨大益处。
