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Indications and surgical options for small bowel, large bowel and perianal Crohn's disease

World journal of Gastroenterology 2016年第40期22卷 8892-8904页

作者： j.mes wt toh Peter Stewart Matthew jFX Rickard Rupert Leong Nelson Wang Christopher j Young Department of Colorectal Surgery Concord Repatriation General Hospital South Western Sydney Clinical School University of New South Wales Liverpool Hospital School of Medicine Western Sydney University Liverpool Hospital Ingham Institute of Applied Research Liverpool Hospital Discipline of Surgery Sydney Medical School the University of Sydney Department of Gastroenterology Concord Repatriation General Hospital Department of Colorectal Surgery Royal Prince Alfred Hospital

Despite advancements in medical therapy of Crohn's disease(CD), majority of patients with CD will eventually require surgical intervention, with at least a third of patients requiring multiple surgeries. It is important to understand the role and timing of surgery, with the goals of therapy to reduce the need for surgery without increasing the odds of emergency surgery and its associated morbidity, as well as to limit surgical recurrence and avoid intestinal failure. The profile of CD patients requiring surgical intervention has changed over the decades with improvements in medical therapy with immunomodulators and biological agents. The most common indication for surgery is obstruction from stricturing disease, followed by abscesses and fistulae. The risk of gastrointestinal bleeding in CD is high but the likelihood of needing surgery for bleeding is low. Most major gastrointestinal bleeding episodes resolve spontaneously, albeit the risk of re-bleeding is high. The risk of colorectal cancer associated with CD is low. While current surgical guidelines recommend a total proctocolectomy for colorectal cancer associated with CD, subtotal colectomy or segmental colectomy with endoscopic surveillance may be a reasonable option. Approximately 20%-40% of CD patients will need perianal surgery during their lifetime. This review assesses the practice parameters and guidelines in the surgical management of CD, with a focus on the indications for surgery in CD(and when not to operate), and a critical evaluation of the timing and surgical options available to improve outcomes and reduce recurrence rates.

关键词： Surgery Crohn’s disease Major abdominal surgery Perianal Inflammatory bowel disease Colon cancer

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