Lapidus A, Bernell O, Hellers G, Löfberg R
Department of Gastroenterology, Karolinska Institute, Huddinge University Hospital, Stockholm, Sweden.
Gastroenterology. 1998 Jun;114(6):1151-60. doi: 10.1016/s0016-5085(98)70420-2.
BACKGROUND & AIMS: Crohn's disease (CD) confined to the colon and rectum is an increasing clinical entity. The aim of this study was to assess the features and clinical course of colorectal CD.
This was a retrospective cohort study of 507 patients in whom colonic or rectal CD had been diagnosed between 1955 and 1989.
Colonic distribution was segmental in 40%, total in 31%, and left-sided in 26%. Perianal/rectal fistulas occurred in 37%. In patients who attained clinical remission, the 5-year cumulative relapse rate after diagnosis was 67% (95% confidence interval [CI], 62-72). At the initial presentation of CD, the frequency of major surgery decreased from 24% to 14% (P < 0.005) over time. Still, the overall long-term probability of major surgery after 10 years was unaltered (49% vs. 47%). The presence of fistulas increased the probability of surgical resection (relative risk [RR], 1.7 [95% CI, 1.3-2.2]), whereas left-sided disease was associated with a decrease (RR, 0.6 [95% CI, 0.4-0.8]). Twenty-four percent of the patients developed inflammation in the small bowel. The cumulative risk for a permanent ileostomy was 25% (95% CI, 21-29) 10 years after diagnosis.
Colorectal CD is an increasing entity carrying substantial morbidity. Half of the patients will undergo surgical resection within the first 10 years, and half of those will ultimately undergo ileostomy. Changed management at diagnosis has not affected the long-term probability of resection.
局限于结肠和直肠的克罗恩病（CD）是一种日益常见的临床病症。本研究旨在评估结直肠CD的特征及临床病程。
这是一项对1955年至1989年间诊断为结肠或直肠CD的507例患者进行的回顾性队列研究。
结肠病变呈节段性分布的占40%，全结肠受累的占31%，左侧结肠受累的占26%。37%的患者出现肛周/直肠瘘。达到临床缓解的患者，诊断后5年累积复发率为67%（95%置信区间[CI]，62 - 72）。在CD初诊时，随着时间推移，大手术的发生率从24%降至14%（P < 0.005）。然而，10年后大手术的总体长期概率未改变（49%对47%）。瘘管的存在增加了手术切除的概率（相对风险[RR]，1.7[95%CI，1.3 - 2.2]），而左侧病变则与之降低相关（RR，0.6[95%CI，0.4 - 0.8]）。24%的患者出现小肠炎症。诊断后10年，永久性回肠造口术的累积风险为25%（95%CI，21 - 29）。
结直肠CD是一种发病率不断上升的病症，具有较高的发病率。半数患者将在发病后的前10年内接受手术切除，其中半数最终将接受回肠造口术。诊断时管理方式的改变并未影响长期切除概率。
