Langzeitergebnisse nach chirurgischer Therapie des Morbus Crohn

 

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Zusammenfassung

Wir führten eine retrospektive Analyse von Patienten nach operativer Therapie des Mb. Crohn durch.
Patienten und Methode: Bei 81 Patienten, die von 1990 bis 1995 an unserer Klinik behandelt wurden, erfolgte die Auswertung der Krankenunterlagen und die postoperative Verlaufsbeobachtung über durchschnittlich 42 Monate.
Ergebnisse: An 81 Patienten wurden insgesamt 88 Operationen durchgeführt. 56 Patienten wurden erstmalig einem resezierenden Verfahren unterzogen. Das Durchschnittsalter betrug 35 Jahre (Min. 14 Jahre, Max. 76 Jahre; 42 Patientinnen und 39 Patienten). Der Mb. Crohn war bei den erstmalig operierten Patienten am häufigsten im Bereich der Ileocoecalklappe lokalisiert, die meist durchgeführte Operation war die Ileocoecalresektion. Die häufigste Operationsindikation bei Patienten mit Dünndarmbefall waren die Obstruktion, bei ileocolitischem Befall die Fistel und bei Patienten mit einer Colitis Crohn die Fistel und die Obstruktion. Komplikationen im frühen postoperativen Verlauf traten bei 14 % der Patienten auf. Die postoperative Letalität betrug 1,1 %. In einem postoperativen Beobachtungszeitraum von im Mittel 3,5 Jahren mussten 3 von 57 Patienten (5 %) aufgrund eines Crohnrezidivs erneut operiert werden. Insgesamt kam es im Zeitraum von 6 Jahren bei 25 der 81 (31 %) Patienten zu einem Rezidiv.
Schlussfolgerung: Mithilfe der chirurgischen Therapie beim Mb. Crohn gelingt es, die Patienten für lange Zeit beschwerde- und rezidivfrei zu halten.

Abstract

We performed a retrospective analysis in patients after operative therapy of Crohn’s disease in our institution.
Patients and Methods: 81 patients that underwent surgery from 1990-1995 were analysed retrospectively. The follow up period in these patients was 42 months.
Results: In 81 patients a total of 88 operations were performed. 56 patients were operated for the first time. The average patient’s age was 35 years (range 14-76 years). Crohn’s disease was located predominantly in the area of the ileocoecal valve. The most frequent operation was the ileocoecal resection. The prevalent operative indication in patients with small intestine Cohn’s disease was the obstruction, in small intestine and colon manifestation the fistula. Complications in the early postoperative course appeared in 14 % of the patients. Postoperative mortality was 1.1 %. In a postoperative observation period of 3.5 years 3 of 57 patients (5 %) had to undergo surgery again, due to recurrence. Altogether 25 of 81 (31 %) patients revealed a recurrence.
Conclusions: The surgical therapy of Crohn’s disease can be performed safely and provides long-term recurrence and complaint free periods.

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Dr. H. Lauschke

Klinik u. Poliklinik f. Allgemein-, Viszeral-, Thorax- und Gefäßchirurgie

Sigmund-Freud-Str. 25

53105 Bonn

Phone: 02 28/287 51 09

Fax: 02 28/287 51 37

Email: lauschke@chir.uni-bonn.de