伴腰大肌脓肿的克罗恩病患者行回盲部切除术是否必须造口？临床病例系列

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论证。在穿透型或狭窄合并穿透型克罗恩病患者中，可能形成腰大肌脓肿。回盲部切除术是复杂克罗恩病最常见的手术方式。在合并腰大肌脓肿的情况下是否能够实施肠道吻合仍存在争议。由于目前缺乏克罗恩病合并腰大肌脓肿患者的明确处理方案，且该病在儿童中较为罕见，因此本研究具有现实意义。

目的。评估合并腰大肌脓肿背景下行回盲部切除术的克罗恩病患者的治疗结果及是否需要造口。

方法。本研究纳入8例 接受腰大肌脓肿背景下回盲部切除术的复杂克罗恩病患者。在8例患者中，有6例（75%）未行造口术，其余患者接受了分期手术并行造口术。所有肠道吻合均采用手工端对端双层缝合。在8例患者中，有7例（87.5%）在术前接受了为期7–14天的广谱抗菌药物治疗，并获得了积极的临床及实验室反应。

结果。有一半患者腰大肌脓肿直径不超过3 cm，且在手术前该组患者均接受了以抗菌药物为主的保守治疗。2例患者脓肿于术中发现并行手术清创。在行回盲部切除术前，8例患者中有7例未接受糖皮质激素治疗，仅1例患者以最低剂量使用泼尼松5 mg。8例患者中有4例（50%）因营养状态不良接受部分肠外营养及白蛋白输注，治疗持续7–14天。8例患者中有4例（50%）发生术后感染性并发症，均为表浅感染，按Clavien–Dindo术后并发症分级不超过 I 级。

结论。腰大肌脓肿是肠道吻合口可能发生不全的因素之一，但并非不良结局的确定性预测指标。若在择期回盲部切除术前发现腰大肌脓肿（视其大小而定），建议先行抗菌治疗或经皮引流，并于5–7天内评估临床反应（退热、炎症指标下降）。在此情况下，7–14天后实施一期肠道吻合是可行的。

作者简介

Victoria A. Glushkova

Saint Petersburg State Pediatric Medical University

编辑信件的主要联系方式.
Email: pedsurgspb@yandex.ru
ORCID iD: 0009-0002-4768-1539
SPIN 代码: 8703-3966
俄罗斯联邦, Saint Petersburg

Аleksey V. Podkamenev

Saint Petersburg State Pediatric Medical University

Email: av.podkamenev@gpmu.org
ORCID iD: 0000-0001-6006-9112
SPIN 代码: 7052-0205

MD, Dr. Sci. (Medicine), Assistant Professor

俄罗斯联邦, Saint Petersburg

Tatyana V. Gabrusskaya

Saint Petersburg State Pediatric Medical University

Email: tatyanagabrusskaya@yandex.ru
ORCID iD: 0000-0002-7931-2263
SPIN 代码: 2853-5956

MD, Cand. Sci. (Medicine), Assistant Professor

俄罗斯联邦, Saint Petersburg

Elena V. Shilova

Saint Petersburg State Pediatric Medical University

Email: komarova_lena@mail.ru
ORCID iD: 0000-0003-2487-0783
俄罗斯联邦, Saint Petersburg

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