PDF(Pubmed)
Abstract：
Crohn\'s disease (CD) remains a chronic, incurable disorder that presents unique challenges to the surgeon. Multiple factors must be considered to allow development of an appropriate treatment plan. Medical therapy often precedes or complements the surgical management. The indications for operative management of CD include acute and chronic disease complications and failed medical therapy. Elective surgery comes into play when patients are refractory to medical treatment if they have an obstructive phenotype. Toxic colitis, acute obstruction, perforation, acute abscess, or massive hemorrhage represent indications for emergency surgery. These patients are generally in critical conditions and present with intra-abdominal sepsis and a preoperative status of immunosuppression and malnutrition that exposes them to a higher risk of complications and mortality. A multidisciplinary team including surgeons, gastroenterologists, radiologists, nutritional support services, and enterostomal therapists are required for optimal patient care and decision making. Management of each emergency should be individualized based on patient age, disease type and duration, and patient goals of care. Moreover, the recurrent nature of disease mandates that we continue searching for innovative medical therapies and operative techniques that reduce the need to repeat surgical operations. In this review, we aimed to discuss the acute complications of CD and their treatment.
摘要：
克罗恩病（CD）仍然是一种慢性疾病，无法治愈的疾病，对外科医生提出了独特的挑战。必须考虑多种因素以允许制定适当的治疗计划。药物治疗通常先于或补充手术管理。CD手术治疗的适应症包括急性和慢性疾病并发症以及药物治疗失败。当患者具有阻塞性表型而难以接受药物治疗时，选择性手术就会发挥作用。毒性结肠炎,急性梗阻,穿孔,急性脓肿,或大出血代表急诊手术的适应症。这些患者通常处于危急状态，并且存在腹内败血症和术前免疫抑制和营养不良状态，这使他们面临更高的并发症和死亡风险。包括外科医生在内的多学科团队，胃肠病学家,放射科医生,营养支持服务，和肠造口治疗师需要最佳的病人护理和决策。每个紧急情况的管理应根据患者年龄进行个性化，疾病类型和持续时间，和病人的护理目标。此外，疾病的复发性要求我们继续寻找创新的医学疗法和手术技术，以减少重复外科手术的需要。在这次审查中,我们旨在讨论CD的急性并发症及其治疗。
