Crohn's Disease: A Clinicopathologic Study of Fiften Cases

克隆氏病：15位病例的臨床病理分析

陳立偉(Li-Wei Chen) ； 張良慈(Liang-Che Chang) ； 簡榮南(Rong-Nan Chien) ； 蘇明堯(Ming-Yao Su) ； 方昆敏(Tsung-Shih Lee) ； 李宗實(Jia-Jang Chang) ； 張家昌(Cho-Li Yen) ； 嚴卓立(Kuan-Meen Fang)

《臺灣消化醫學雜誌》 26卷1期 (2009/03) Pp. 1-7

https://doi.org/10.6557/GJT.200903_26(1).0001

摘要

克隆氏病是一種慢性，局部發炎的腸病，好發於小腸末端及大腸初始部位。本研究回溯分析15例經病理證實的克隆氏病患（11位男性，4位女性）。病患平均44.0±16.1歲。從發病到確定診斷平均爲1.1年（範圍從數天到3年）。主要的症狀爲腹痛（13/15，佔87%）及嘔吐（11/15，佔73%）。十二位病患接受手術及藥物治療，其餘三位僅接受藥物控制。最常好發的部位爲迴腸末端(12/15, 73%)，盲腸(9/15, 60%)及闌尾(4/15, 27%)。十一位病人接受鋇劑影像學檢查或大腸鏡檢，發現4例腸狹窄（4/11，佔36%）。臨床上，口瘡式潰瘍(aphthous ulcer)是最常見的表現（10/15，佔67%）。顯微鏡檢下，常見淋巴球浸潤的發炎反應(15/15, 100%)，非乾酪壞死性肉芽腫(13/15, 87%)及整層腸壁的發炎(transmural involvement, 10/15, 67%)。藥物方面，Mesalazine or Sulfasalazine (10/15, 67%)及Prednisolone (6/15, 40%)常被使用。有4位病患因爲反覆性腸狹窄，阻塞，膿瘍及瘻管需再次手術治療。一位合併B型肝炎帶原的病人在，停止類固醇給藥後，經歷一次急性肝炎的發作。有兩位同時合併胃食道逆流的病患，服用氫離子阻斷劑仍未完全治癒的食道潰瘍，在類固醇給藥後，潰瘍癒合。有鑑於臺灣是B型肝炎及結核的好發地區，克隆氏病患者，如果需要使用免疫抑制劑如類固醇時，應先篩檢這兩種疾病。

關鍵字

克隆氏病 ； 大腸疾病 ； 潰瘍

並列摘要

Crohn's disease is a chronic segmental inflammatory bowel disease with a propensity in the distal small bowel and the proximal large bowel. This study retrospectively analyzed fifteen (eleven male and four female) pathologically-proven cases. Mean age of the patients was 44.0±16.1 years old. Mean duration from initial symptoms to diagnosis was 1.1 year (range, several days to 3 years). The main symptoms were abdominal pain (13/15, 87%) and nausea/vomiting (11/15, 73%). Twelve patients received surgical treatment, and three received only drug therapy. The most commonly involved bowels were terminal ileum (12/15, 80%), cecum (9/15, 60%) and appendix (4/15, 27%). Image studies of 11 patients revealed bowel stricture in 4 patients (4/11, 36%). Clinically, aphthous ulcer was the most common finding (10/15, 67%). Microscopic findings included lymphocyte infiltration (15/15, 100%), non-caseous granuloma (13/15, 87%) and transmural involvement (10/15, 67%). All patients received drug therapy with mesalazine/ sulfasalazine (10/15, 67%) or prednisolone (6/15, 40%). Repeated operation was performed in 4 patients due to recurrent stricture, bowel obstruction, abscess, and fistula formation. Steroid therapy healed esophageal ulcers in two gastroesophageal reflux disease patients who had failed to respond to proton pump inhibitor therapy. However, one chronic hepatitis B patient developed acute exacerbation after steroid therapy for Crohn's disease. Because Taiwan is an epidemic area for tuberculosis and viral hepatitis, patients must be surveyed for tuberculosis and viral hepatitis before prescribing steroid treatment.

並列關鍵字

Crohn's disease ； colon disease ； ulcer