Clinical Experience in Crohn's Disease of Small Intestine

小腸克隆氏病的臨床經驗

黃俊彥(Chun-Yen Huang) ； 辛政憲(Jeng-Shinn Shin) ； 黃仁杰(Jen-Chieh Huang) ； 方俊慧(Fred Fang) ； 任佩鸞(Pei-Lung Ren) ； 黃一修(Yi-Siu Huang) ； 黃裕庭(Yue-Ting Huang) ； 趙哲仁(Che-Jen Chao) ； 潘大猷(Ta-Yu Pan)

《中華民國消化系醫學雜誌》 17卷4期 (2000/12) Pp. 246-251

https://doi.org/10.6557/GJTb.200012_17(4).0001

摘要

發炎性腸疾病在台灣是不常見的疾病，而克隆氏病甚至更少。我們的目的是去研究小腸克隆氏病的臨床表現。從1993年一月到1999年三月，共有五位患者在經過一系列的檢查包括胃鏡、大腸鏡、小腸鋇劑攝影檢查後被診斷爲小腸克隆氏病，五例病人均接受手術治療而病理檢查也符合克隆氏病之診斷。病人的平均年齡為32~45歲，全部是男性，從出現症狀到診斷確立的時間由六個月到三年不等，所有的病人皆有不同的腸胃道症狀，但除了其中一位病人有右腎結石的情形外，其他病人都沒有出現腸道外的表徵，四例有右下腹痛，四例有慢性腹瀉，二例有右下腹腫塊，二例有嚴重的嘔吐現象，所有的病人皆出現明顯的體重下降及營養不良的情形，所有的病人都因爲腸阻塞或局部性腹膜炎而接受手術治療，並且在術後接受長期的Sulfasalazine維持治療，所有的病例在平均之治療46個月內都沒有出現症狀。我們的結論是因爲小腸克隆氏病非常少見，所以，常常會被誤診或延誤診斷，詳細地詢問病史，保持高度的臨床懷疑及作適當地X光造影檢查將會使得診斷較容易，對於出現腸阻塞症狀的克隆氏症，手術仍然扮演重要的角色。

關鍵字

克隆氏病 ； 小腸

並列摘要

Inflammatory bowel disease was uncommon in Taiwan, and Crohn's disease was even rarer. Our aim is to study the clinical presentation in patients with Crohn's disease of small intestine. From January 1993 to January 2000, after a series of examination including panendoscopy, colonoscopy and small bowel barium study, five patients were diagnosed to have Crohn's disease of small intestine. All these cases had received surgical treatment and the pathological results were compatible with the diagnosis of Crohn's disease. The ages of our patients ranged from 32 to 45 years. All five cases were male. The durations of symptoms, from onset to final diagnosis, varied from 6 months to 3 years. All the cases had variable gastrointestinal symptoms. Only one case had right renal stone, but none of the other four cases had extraintestinal manifestations. Four patients had chronic right lower quadrant abdominal pain, four patients have chronic diarrhea, two patients have felt right quadrant abdominal mass, severe nausea and vomiting were noted in two cases, and malnutrition and significant body weight loss were noted in all five cases (10kg-15kg in 6 months to 1 year). All the cases received operations far intestinal obstruction or local peritonitis, followed by long term sulfasalazine treatment. All cases remained symptom free in the average 46 months fallow-up period (13 months to 87 months). Because Crohn's disease is rare in Taiwan, detailed history taking, high clinical suspicion and adequate imaging study are needed to make the diagnosis. Surgery remained to be the mainstay in the treatment of complications of Crohn's disease. Maintenance therapy with sulfasalazine may prolong the remission time after surgical intervention.

並列關鍵字

Crohn's disease ； small intestine