Surgical and Nutritional Intervention of Crohn's Disease

克隆氏症的手術治療及營養治療

劉張惠泉(Huei-Chiuan Liuchang) ； 許自齊(Tzu-Chi Hsu)

《中華民國大腸直腸外科醫學會雜誌》 20卷1期 (2009/03) Pp. 20-25

https://doi.org/10.6312/SCRSTW.2009.20(1).09721

摘要

目的　克隆氏症的治療，通常採取的是保守性治療。手術治療大都用於緩解克隆氏症的併發症。對於大多數的臨床醫師來說，由於克隆氏症在台灣地區的發生率遠比西方國家低，因此克隆氏症之手術治療及營養治療的經驗的確比較缺乏。這篇回顧性研究分析，主要是呈現單一外科醫師對於克隆氏症的手術適應症，手術術式，手術結果，及營養治療的結果。
方法　從1983年12月到2006年10月，共收集19位罹患克隆氏症患者資料，這些患者都接受同一位外科醫師的手術治療。這些研究資料包括克隆氏症手術治療的適應症，手術術式，手術次數（包括在其他醫院的手術次數），死亡率，併發症，營養指標，及全靜脈營養治療相關的併發症。
結果　這些克隆氏症患者共計有12位男性及7位女性。其平均年齡約38.1歲（範圍從14歲到65歲）。最常見的手術適應症是頑固性疾病(56.2%)。最常見的手術術式為右側部分大腸切除術合併腸道吻合術(56.2%)。除了一位病患失去追蹤治療之外，其他病患皆呈現出復發性或持續性疾病。共有五位病患死亡。大多數患者可藉由異常的營養指標呈現出病患術前營養不良的狀況。
結論　外科手術治療應用於緩解克隆氏症的併發症。營養不良常併發於克隆氏症患者。應保留足夠的腸道長度以避免短腸症候群。手術前後全靜脈營養治療可適用於持續性營養不良或疾病相關併發症。

關鍵字

克隆氏症患者 ； 手術治療 ； 營養治療

並列摘要

Purpose. Crohn's disease is usually treated conservatively. The surgery is reserved for treating complications of Crohn's disease. Experience of surgical treatment and nutritional interventions of Crohn's disease for most physicians is relatively limited because of incidence of Crohn's disease in Taiwan is much lower than western countries. This is retrospective review of a single surgeon's experience of indications, procedures, and results of surgery, and nutritional interventions for Crohn's disease.
Materials and Methods. We collected 19 patients, from December 1983 to October 2006, who had surgical treatment for Crohn's disease by a single surgeon. Data including surgical indications and type of surgery for Crohn's disease, number of operations (including operations in other hospitals), mortality, morbidity, nutritional parameters, TPN related complications were analyzed.
Results. There were 12 males and 7 females. The average age was 38.1 year old (range from 14 to 65 years). The most common indications for surgery were intractable disease (56.2%). The most common operation was right partial colectomy with anastomosis (56.2%). One patient was lost in follow up, the rest of patients all had recurrent or persisted disease. Five patients expired. Majority of patients had preoperative malnutrition manifested by abnormal nutritional parameters.
Conclusions. The surgery is reserved for treating complications of Crohn's disease. Malnutrition is common in the patient who had Crohn's disease. Preservation of length of bowel is essential to avoid short bowel syndrome. Perioperatively parenteral nutrition is frequently indicated due to persisting malnutrition or associated complications.

並列關鍵字

Crohn's disease ； Surgical and Nutritional intervention