Yamamoto T, Bain I M, Connolly A B, Keighley M R
University Department of Surgery, Queen Elizabeth Hospital, Edgbaston, Birmingham, United Kingdom.
Dis Colon Rectum. 1998 Oct;41(10):1287-92. doi: 10.1007/BF02258230.
The aim of this study was to assess the clinical features and management of fistulas involving the stomach and duodenum (gastroduodenal fistulas) in patients with Crohn's disease.
The medical records of 14 patients with a gastroduodenal fistula complicating Crohn's disease treated in this unit between 1958 and 1997 were reviewed.
In six patients a gastroduodenal fistula was diagnosed before surgery, whereas eight gastroduodenal fistulas were discovered during surgery for distal Crohn's disease. In six patients, the fistula originated from Crohn's disease in the transverse colon, and in six patients, it originated from a recurrent disease at an ileocolonic anastomosis; these patients had no gross evidence of gastroduodenal Crohn's disease. In one patient, the ileocolonic-duodenal fistula closed on medical treatment. The other 11 patients underwent resection of the diseased bowel and closure of the gastric or duodenal fistulas. The two remaining fistulas were from the duodenum to the abdominal wall; both had primary Crohn's duodenitis. One duodenocutaneous fistula was treated by debridement of the duodenal fistula and simple closure of the defect; the other was treated by limited duodenal excision around the fistula and by duodenojejunostomy. In all patients, gastroduodenal fistulas were cured, and there have been no fistula recurrences.
Simple closure of the gastroduodenal component of the fistula is generally advised for gastroduodenal fistulas. However, when the duodenal defect after excision around the fistula is large, duodenojejunostomy is recommended, provided there is no evidence of jejunal Crohn's disease.
本研究旨在评估克罗恩病患者胃十二指肠瘘（胃十二指肠瘘）的临床特征及治疗方法。
回顾了1958年至1997年间在本单位接受治疗的14例并发克罗恩病的胃十二指肠瘘患者的病历。
6例患者在手术前被诊断为胃十二指肠瘘，而8例胃十二指肠瘘是在远端克罗恩病手术过程中发现的。6例患者的瘘起源于横结肠的克罗恩病，6例患者的瘘起源于回结肠吻合口的复发性疾病；这些患者没有胃十二指肠克罗恩病的明显证据。1例患者的回结肠-十二指肠瘘经药物治疗后闭合。其他11例患者接受了病变肠段切除及胃或十二指肠瘘闭合术。其余2例瘘为十二指肠至腹壁瘘；两者均有原发性克罗恩十二指肠炎症。1例十二指肠皮肤瘘通过十二指肠瘘清创及缺损简单闭合治疗；另1例通过瘘周围有限的十二指肠切除及十二指肠空肠吻合术治疗。所有患者的胃十二指肠瘘均治愈，且无瘘复发。
对于胃十二指肠瘘，一般建议简单闭合瘘的胃十二指肠部分。然而，如果瘘周围切除后十二指肠缺损较大，且无空肠克罗恩病证据，建议行十二指肠空肠吻合术。
