Surgical Experience of Crohn's Disease-A Single-Center 30-year Case Analysis

克隆氏症的外科經驗－單一醫學中心三十年之資料分析

陳志典(Chih-Tien Chen) ； 王輝明(Hwei-Ming Wang) ； 陳周斌(Joe-Bin Chen) ； 陳周誠(Chou-Chen Chen) ； 馬秀峰(Hsiu-Feng Mar) ； 蔣鋒帆(Feng-Fan Chiang) ； 林冠名(Kuan-Min Lin) ； 趙德馨(Te-Hsin Chao)

《中華民國大腸直腸外科醫學會雜誌》 26卷1期 (2015/03) Pp. 30-37

https://doi.org/10.6312/SCRSTW.2015.26(1).10326

摘要

背景　克隆氏症在亞洲是一個相對罕見的疾病。本篇研究旨在探討台灣克隆氏症的臨床特性，進而達到早期診斷及改善預後之目的。方法 本篇資料蒐集自台中榮總臨床研究中心資料庫。我們整理了從1984年到2014年的64個患者，並檢視了包括年齡、病灶處、初始症狀及手術紀錄等病歷資料。結果　在所有病人中，女男比例為0.39:1，平均年齡為37.73歲。整體年齡分布最多在21～30歲，男性是有兩個好發年齡層而女性只有一個。以蒙特婁分類來區分的話，L2是病灶處最常出現的位置，然後依序是L1，L3和L4。消化道出血是最常見的臨床症狀（29.69%）。至於初始診斷，有67.19%的病人被診斷為其他疾病，只有32.81%的病人被證實或是懷疑是克隆氏症。79.69%的病人因為克隆氏症的併發症而手術，其中94.11%的病人接受了腸道切除的手術。這些病人之中有35.2%的人在7年內必須再經歷一次手術治療。結論　因為克隆氏症在台灣比較罕見，大部分的病人診斷容易被延誤，而多數病人因此必須接受手術處理晚期的併發症。我們有必要改良診斷方式以減少手術介入的必要性。

關鍵字

克隆氏症 ； 延遲診斷 ； 克隆氏症手術

並列摘要

Background. Crohn's disease is a relatively rare disease in Asian. An increasing incidence has been observed but domestic data for Crohn's disease was still lacking. The aim of this study was to assess the clinical course of Crohn's disease and the role of surgery in the treatment of Crohn's disease, in the intension to provide reference on clinical judgements. Methods. This study used data obtained from the Taichung Veterans General Hospital (VGHTC) Clinical Informatics Research and Development Center (CIRDC) database. The patients with diagnosis of Crohn's disease from 1984 to 2014 in VGHTC were screened. Sixty-four patients with Crohn's disease were identified and included in this study. Clinical records (age, location of the lesion and initial symptoms) and surgery records were reviewed for each patient. Results. The female/male ratio was 0.39:1, and the mean age at diagnosis was 37.73 years. Overall, the incidence peaked in those aged 21-30 years, with two peaks in the male patients and one peak in the female patients. In Montreal classification, L2 (37.5%) was the most common location of Crohn's disease, followed by L1, L3, and L4. Gastrointestinal bleeding was the most common clinical symptom (29.69%). In the initial diagnosis, 67.19% of the patients were diagnosed with other entities. Only 32.81% of the patients were proven to have or suspected of having Crohn's disease. 79.69% of the patients underwent surgery for a complication of Crohn's disease, 94.11% of whom underwent intestinal resection. 35.2% of the patients who underwent surgery required a second surgery within seven years. Conclusion. Due to the rarity of Crohn's disease in Taiwan, the diagnosis was often missed and most of the patients received surgery for late complications. Improved diagnostic modalities are needed to decrease the requirement for surgical interventions.

並列關鍵字

Crohn's disease ； Delayed diagnosis ； Crohn's surgery

參考文獻

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