目的探讨肠外和肠内营养支持在克罗恩病围手术期的应用价值。方法对我院1995～2001年经手术治疗的20例克罗恩病进行回顾性分析。结果经肠内及肠外营养支持后，该20例克罗恩病围手术期的各项营养指标均有不同程度改善，且无营养不良的并发症发生。结论营养支持是克罗恩病围手术期的重要治疗手段，适时合理地应用肠外和肠内营养，有助于提高该病的手术疗效。
目的 探讨英夫利西单抗治疗克罗恩病（CD）在临床护理中的有效管理措施。 方法 对2011年9月—2012年8月静脉输注英夫利西单抗的25例住院患者，在药物配伍、输注流程、配制方法等方面予以严格管理，并严密观察药物不良反应和积极做好健康宣教。 结果 经过精心的观察、护理和有效的护理管理措施，25例患者用药6周后体温恢复正常，大便次数1～2次/d，大便隐血试验阴性，腹痛、腹胀症状缓解，体重增加2～7 kg。 结论 在英夫利西单抗药物临床输注过程中，实施有效的输注护理管理措施是确保患者治疗安全以及提高护理质量的重要保障。
目的 分析克罗恩病的临床特点、内镜表现、病理特点、误诊原因，为克罗恩病的诊治提供临床经验。 方法 回顾性分析河南省人民医院2004年1月－2011年12月38例克罗恩病临床特点，并对误诊情况及原因进行分析。 结果 38例小肠克罗恩病患者，症状主要表现为腹痛、腹泻及便血。病变多位于末端回肠和回盲部，最常见的并发症为肠梗阻。结肠镜下可见节段性黏膜充血水肿、铺路石样改变、多发不规则溃疡；病理示全壁性炎症、深裂隙状纵行溃疡及非干酪性肉芽肿。克罗恩病的诊断主要依靠内镜及病理。 结论 克罗恩病临床表现复杂多样，临床误诊、漏诊情况较为多见，需进一步提高对克罗恩病的认识。
目的 探讨外科治疗克罗恩病的手术时机及手术方式。方法 回顾性分析了1998～2012年期间笔者所在医院收治的13例克罗恩病手术患者的临床资料。结果 13例患者中行急诊手术6例，择期手术7例；行左半结肠切除术2例，回盲部并小肠切除术4例，部分小肠切除术4例，右半结肠切除术2例，全结肠切除回肠造口术1例。本组仅7例获随访，随访时间12～48个月，平均38个月，有2例患者分别于术后16个月和31个月死亡，死亡原因为营养不良，消化道出血，多脏器功能衰竭；另外5例预后良好。结论 对克罗恩病正确把握手术时机及选择手术方式，围手术期结合激素及免疫抑制剂治疗是取得满意治疗效果的关键。
ObjectiveTo summarize the recent progress in studies of intestinal immunity in inflammatory bowel disease (IBD). MethodsThe literatures on studying the intestinal immunity in IBD, including ulcerative colitis and Crohn disease were reviewed and analyzed. ResultsIBD comprised two main diseases that cause inflammation of the intestines: ulcerative colitis and Crohn disease. Although the diseases had some features in common, there were some important differences in clinical symptoms and pathological features. Accumulating evidence suggested that IBD results from an inappropriate inflammatory response to intestinal microbes in a genetically susceptible host. Immunity studies highlighted the importance of host-microbe interactions in the pathogenesis of these diseases. Prominent among these findings were genomic regions containing nucleotide oligomerization domain 2 (NOD2), autophagy genes, miRNAs, and components of the interleukin-23/type 17 helper T-cell (Th17) pathway. The disfunction of the intestinal microbiome, intestinal epithelium, intestinal immune cells, and the intestinal vasculature played a key role in the process of IBD. The treatment with monoclonal antibody had been introduced to treat IBD and had been certificated effective. ConclusionThe study of basic intestinal immunity and regulation network of molecules in pathogenic process of IBD provides theory basis on prevention of IBD, while related genes of IBD can offer more gene therapy targets.
ObjectiveTo compare Crohn disease(CD) with intestinal tuberculosis(ITB) in clinical and multislice CT(MSCT) features that may be helpful for the differential diagnosis. MethodsThirty-eight patients with CD and 13 with ITB proved surgically and pathologically were recruited for this study. The clinical symptoms, laboratory, and MSCT findings in these patients were retrospectively analyzed. ResultsThe MSCT changes helpful in distinguishing CD from ITB included:①CD presented symmetrical intestinal wall thickening in most cases, while ITB were asymmetric (P < 0.05).②The irregular stricture was more common usually shown in CD groups, while coaxial in ITB(P < 0.05).③The lymphadenopathy with obvious enhancement and tortuously mesenteric vessels were frequently found in ITB group (P < 0.05). The clinical features of CD including abdominal pain, diarrhea, fever, anemia, hematochezia, weight loss, and intestinal complications were similar with ITB, and similar results were detected in the laboratory examination including the acceleration of erythrocyte sedimentation rate, postive C-reactive protein, and the reduction of albumin. The feature of hematochezia was more common in CD than in ITB, while concomitant pulmonary tuberculosis was more revealed in ITB(P < 0.05). ConclusionsThe MSCT findings of CD and ITB are characteristic. Combined with the similar clinical and laboratory features, the features of MSCT maybe helpful for definitive diagnosis.