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首页> 外文期刊>Seminars in Gastrointestinal Disease >The long-term results of resection and multiple resections in Crohn's disease.
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The long-term results of resection and multiple resections in Crohn's disease.

机译：克罗恩病切除和多次切除的长期结果。

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摘要

Crohn's disease is a panenteric, transmural inflammatory disease of unknown origin. Although primarily managed medically, 70% to 90% of patients will require surgical intervention. Surgery for small bowel Crohn's is usually necessary for unrelenting stenotic complications of the disease. Fistula, abscess, and perforation can also necessitate surgical intervention. Most patients benefit from resection or strictureplasty with an improved quality of life and remission of disease, but recurrence is common and 33% to 82% of patients will need a second operation, and 22% to 33% will require more than two resections. Short-bowel syndrome is unavoidable in a small percentage of Crohn's patients because of recurrent resection of affected small bowel and inflammatory destruction of the remaining mucosa. Although previously a lethal and unrelenting disease with death caused by malnutrition, patients with short-bowel syndrome today can lead productive lives with maintenance on total parenteral nutrition (TPN). This lifestyle, however, does not come without a price. Severe TPN-related complications, such as sepsis of indwelling central venous catheters and liver failure, do occur. Future developments will focus on more powerful and effective anti-inflammatory medication specifically targeting the immune mechanisms responsible for Crohn's disease. Successful medical management of the disease will alleviate the need for surgical resection and reduce the frequency of short-bowel syndrome. Improving the efficacy of immunosuppression and the understanding of tolerance induction should increase the safety and applicability of small-bowel transplant for those with short gut. Tissue engineering offers the potential to avoid immunosuppression altogether and supplement intestinal length using the patient's own tissues.
机译：克罗恩氏病是一种来源不明的全肠透壁炎性疾病。尽管主要通过医学手段进行管理，但仍有70％至90％的患者需要手术干预。小肠克罗恩氏病的手术通常是无情的狭窄并发症的必要方法。瘘，脓肿和穿孔也可能需要手术干预。大多数患者受益于切除或狭窄成形术，生活质量和疾病缓解得到改善，但复发很常见，33％至82％的患者将需要第二次手术，而22％至33％的患者将需要两次以上的切除术。在小部分克罗恩病患者中，短肠综合征是不可避免的，因为反复切除受影响的小肠和剩余粘膜的炎症破坏。尽管以前是由营养不良导致的致命性和持久性疾病，但如今，短肠综合症患者可以维持总肠胃外营养（TPN）来维持生产性生活。但是，这种生活方式并非没有代价。确实发生了严重的TPN相关并发症，例如留置中心静脉导管脓毒症和肝功能衰竭。未来的发展将集中在更强大和有效的抗炎药上，这些药物专门针对克罗恩氏病的免疫机制。对疾病进行成功的医学管理将减轻对手术切除的需要，并减少短博综合征的发生频率。提高免疫抑制的疗效和对耐受性诱导的理解应增加小肠移植物对短肠患者的安全性和适用性。组织工程学提供了完全避免免疫抑制并利用患者自己的组织补充肠道长度的潜力。

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