Young-Fadok T M, Wolff B G, Meagher A, Benn P L, Dozois R R
Division of Colon and Rectal Surgery, Mayo Clinic, Rochester, Minnesota 55905, USA.
Dis Colon Rectum. 1997 May;40(5):558-61. doi: 10.1007/BF02055378.
Ileosigmoid fistulas are found in Crohn's disease and may present a surgical dilemma.
This study was designed to examine surgical practice to determine types of intervention, enumerate complications, and elicit guidelines for surgical management.
The medical records of patients with ileosigmoid fistula and Crohn's disease from 1975 to 1995 were reviewed.
Ninety patients (44 men) were studied. A preoperative diagnosis of ileosigmoid fistula was made in 77 percent of patients. Sigmoid repair was performed in 43 patients (47.8 percent), sigmoid resection in 32 patients (35.6 percent), 12 patients (13.3 percent) underwent more extensive procedures, and 3 patients (3.3 percent) either had surgery elsewhere or were observed. The fistula was never directly responsible for a stoma. The repair and resection groups were similar with respect to age, length of Crohn's disease, and preoperative symptoms. There was no significant difference between groups in the incidence of postoperative complications; there were no postoperative deaths. Average length of stay was 8.3 days following repair and 9.9 days after resection. Reasons for resection included significant purulence or inflammation, a large fistula defect, a defect on the mesenteric border of the sigmoid, and active sigmoid Crohn's disease. Surgeon's assessment of the presence of Crohn's disease in the sigmoid correlated with pathologic examination and was aided by knowledge of recent endoscopic appearance and biopsy results; intraoperative frozen section and colonoscopy were helpful in distinguishing serosal inflammation from active Crohn's disease.
Contrast studies identified 77 percent of ileosigmoid fistulas preoperatively. Performing repair rather than resection does not increase the risk of complications, if standard surgical principles are followed. Preoperative or intraoperative endoscopy assists the surgical evaluation of the sigmoid.
回肠乙状结肠瘘在克罗恩病中较为常见，可能会给手术带来难题。
本研究旨在探讨手术治疗方法，确定干预类型，列举并发症，并得出手术管理指南。
回顾了1975年至1995年期间患有回肠乙状结肠瘘和克罗恩病患者的病历。
共研究了90例患者（44例男性）。77%的患者术前诊断为回肠乙状结肠瘘。43例患者（47.8%）进行了乙状结肠修补术，32例患者（35.6%）进行了乙状结肠切除术，12例患者（13.3%）接受了更广泛的手术，3例患者（3.3%）在其他地方接受了手术或接受观察。瘘管从未直接导致造口。修补组和切除组在年龄、克罗恩病病程和术前症状方面相似。两组术后并发症发生率无显著差异；无术后死亡病例。修补术后平均住院时间为8.3天，切除术后为9.9天。切除的原因包括严重化脓或炎症、较大的瘘管缺损、乙状结肠系膜缘缺损以及活动性乙状结肠克罗恩病。外科医生对乙状结肠中克罗恩病存在情况的评估与病理检查相关，并且通过了解近期内镜检查结果和活检结果得到辅助；术中冰冻切片和结肠镜检查有助于区分浆膜炎症和活动性克罗恩病。
对比研究术前发现了77%的回肠乙状结肠瘘。如果遵循标准手术原则，进行修补而非切除不会增加并发症风险。术前或术中内镜检查有助于乙状结肠的手术评估。
