Abordari chirurgicale moderne in boala crohn
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TIMIŞ, Tudor, HOTINEANU, Adrian, GHIŢU, Valeriu, BENDELIC, Valentin, PALII, Lucian. Abordari chirurgicale moderne in boala crohn. In: Chirurgia (București, Romania), 2022, vol. 117, supl. nr. 1, p. 286. ISSN 1221-9118.
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Chirurgia (București, Romania)
Volumul 117, Supliment nr. 1 / 2022 / ISSN 1221-9118

Abordari chirurgicale moderne in boala crohn
Modern surgical approaches in crohn's disease

Pag. 286-286

Timiş Tudor, Hotineanu Adrian, Ghiţu Valeriu, Bendelic Valentin, Palii Lucian
 
Universitatea de Stat de Medicină şi Farmacie „Nicolae Testemiţanu“
 
Disponibil în IBN: 6 iunie 2022


Rezumat

Introducere. Diagnosticul corect timpuriu, implicatiile chirurgicale oportune constituie premizele succesului in tratamentul bolii Crohn. Scopul. Imbunatatirea diagnosticului, rezultatelor postoperatorii precoce si tardive in boala Crohn (BC) cu localizare intestinala si perineala. Material si metode. In perioada 2000-2021 in Clinica 1 a Catedrei 2 Chirurgie au fost asistati 314 pacienti cu boli inflamatorii intestinale, dintre care 108 (34.4%) pacienti cu BC. Au fost operati 67 (62.1%) bolnavi cu BC: forma intestinala – 38 (56.7%), forma perineala – 29 (43.3%) cazuri respectiv. Operatiile realizate: rezectia segmentara a intestinului subtire (10) sau gros (7) cu anastomoza, hemicolectomie (9), colectomie subtotala (5), stricturoplastie intestinala (4), rezectia rectului cu anastomoza (3), drenajul abcesului perianal (5), excizia fistulei anorectale (4), tratamentul fistulei anorectale cu seton (6), stricturotomie cu stricturoplastie anala (4), excizia fistulei recto-vaginale si inchiderea defectului cu petic mucosal ?la intampinare? (5), excizia fistulei recto-vezicale (3), ileostomie (2). Rezultate. Analiza comparativa a rezultatelor postoperatorii in BC (intestinala si perineala) a evidentiat frecventa mai inalta a recidivelor bolii in primii 5 ani (28.9% vs 41.4%), complicatiilor postoperatorii (21.1% vs 34.5%) si operatiilor repetate pentru ele (13.2% vs 27.6%) in forma perianala. Concluzii. In baza datelor clinice, radiologice, endoscopice si histologice, diagnosticul cert al bolii Crohn a fost posibil in 72.7% cazuri. Atitudinea medico-chirurgicala, individualizata la fiecare caz, a redus letalitatea postoperatorie pina la 7.9% (forma intestinala) si 3.4% (forma perineala).

Introduction. Early correct diagnosis, timed surgical implications constitute preconditions for success in the treatment of Crohn's disease. Goal. Improvement of the diagnosis, early and late postoperative results in CD with intestinal and perineal localization. Material and methods. During 2000-2021 period, in Surgical Department №2 were assisted 314 patients with IBD, of which 108 (34.4%) patients with CD. There were 67 (62.1%) operated patients with CD: intestinal form – 38 (56.7%), perineal form – 29 (43.3%) cases respectively. Performed operations: segmental resection of small (10) or large bowel (7) with anastomosis, right/left hemicolectomy (9), subtotal colectomy (5), liquidation of intestinal stricture (4), rectal resection with anastomosis (3), drainage of perianal abscess (5), excision of anorectal fistula (4), treatment of anorectal fistula with long-term setons (6), incision of anal stricture (4), excision of recto-vesical (3) and recto-vaginal fistulas (5), ileostomy (2). Results. Comparative analysis of postoperative results showed a higher frequency of relapses of the disease during the first 5 years (28.9% vs 41.4%), postoperative complications (21.1% vs 34.5%) and repeated operations for them (27.6% vs 13.2%) in the perineal form. Conclusions. Based on clinical, radiological, endoscopic and histological data, the diagnosis of CD has been possible in 72.7% cases. Therapeutic and surgical attitude, individualized to each case, reduced postoperative lethality up to 7.9% (intestinal form) and 3.4% (perineal form).

Cuvinte-cheie
chirurgie, Crohn intestinala perianala,

surgery, perianal intestinal Crohn