中国克罗恩病并发肠瘘诊治的专家共识意见

Crohn's disease is a chronic inflammatory disease involving the entire layer of the digestive tract, and intestinal fistula is its most serious surgical complication. The treatment goals are to cure intestinal fistula and abdominal cavity infection, restore the continuity of the digestive tract, reduce postoperative recurrence and improve the quality of life. Clinically, the intestinal fistula complicated by Crohn's disease should be fully evaluated, and efforts should be made to promote the spontaneous healing of the intestinal fistula. The combination of enteral nutrition and surgical drainage is helpful to promote the spontaneous healing of the intestinal fistula. At the same time, attention should be paid to the evaluation of the nutritional status during the perioperative period, and nutritional support treatment should be given. For the combined abdominal abscess, it is recommended to use a Trocar for puncture and placement of a double-cannula to establish an active irrigation and drainage. For the external and internal fistulas complicated by Crohn's disease that cannot be cured by drugs, nutritional treatment and surgical drainage, surgical treatment should be considered. Laparoscopic surgery is recommended for the intestinal fistula complicated by Crohn's disease with less adhesion. After the operation, drug treatment should be given and regular reexamination should be carried out to reduce the postoperative recurrence of Crohn's disease and the recurrence of intestinal fistula as much as possible.

克罗恩病是累及消化道全层的慢性炎性疾病,肠瘘是其最为严重的外科并发症.治疗目标是治愈肠瘘与腹腔感染、恢复消化道的连续性、减少术后复发和改善生活质量.临床上应对克罗恩病并发的肠瘘进行充分评估,努力促进肠瘘的自行愈合,联合肠内营养与外科引流有助于促进肠瘘自行愈合.同时要重视围手术期营养状况的评估,并给予营养支持治疗.合并的腹腔脓肿建议使用Trocar穿刺置双套管建立主动冲洗引流.药物、营养治疗以及外科引流未能治愈的克罗恩病并发的肠外瘘与肠内瘘,需要考虑手术治疗,推荐腹腔镜手术应用于粘连较轻的克罗恩病并发的肠瘘.术后予以药物治疗并定期复查,尽可能减少克罗恩病术后复发以及肠瘘的再发.