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目的探讨克罗恩病(CD)并发急性下消化道出血(ALGIH)的风险因素及处理措施。方法回顾性分析南京军区南京总医院2007年1月至2013年6月收治的73例CD并发ALGIH病人的临床及随访资料。结果收治的CD病人共1374例,其中因ALGIH就诊的占5.3%(73/1374)。Logistic回归提示病变累及左半结肠及既往出血史为CD并发ALGIH的独立危险因素。排除死亡及自行出院的8例,36例CD病人通过内科治疗后出血停止,其余29例为外科手术治疗。17例内科治疗的病人在随访期间再次出现了下消化道出血。而手术治疗的病人仅6例再次出现下消化道出血,其出血复发的风险要小于内科治疗。结论病变累及左半结肠及既往有出血史的CD病人出现ALGIH的风险加大。如何预防出血复发仍然是一个难点,应引起临床医师重视。
Objective To explore the risk factors and treatment of Crohn’s disease (CD) complicated with acute lower gastrointestinal bleeding (ALGIH). Methods The clinical and follow-up data of 73 CD patients with ALGIH who were admitted to Nanjing General Hospital of Nanjing Military Command from January 2007 to June 2013 were retrospectively analyzed. Results A total of 1374 CD patients were admitted, of whom 5.3% (73/1374) received ALGIH treatment. Logistic regression suggested that the lesion involved the history of left colon and previous history of bleeding as an independent risk factor for CD complicated with ALGIH. Excluding the death and discharge of 8 cases, 36 cases of CD patients stopped bleeding after medical treatment, and the remaining 29 cases were treated surgically. 17 cases of medical treatment of patients again during the follow-up of lower gastrointestinal bleeding. Only 6 cases of surgical treatment of patients with lower gastrointestinal bleeding again, the risk of recurrence of bleeding is less than the medical treatment. Conclusions The risk of developing ALGIH is increased in CD patients with lesions involving the left colon and with previous history of bleeding. How to prevent the recurrence of bleeding is still a difficult task that should be taken seriously by clinicians.