目的    探讨肠内营养治疗对克罗恩病并发管状外瘘的临床效果。方法    回顾性分析2007年5月至2011年12月南京军区南京总医院普通外科收治的克罗恩病并发管状外瘘43例病人，应用半要素肠内营养治疗3个月的临床资料。记录经肠内营养治疗后肠瘘是否愈合、愈合时间，以及治疗前后的炎症指标C反应蛋白（CRP）、血沉（ESR）、血小板（Plt），营养指标体重、身体质量指数（BMI）、血红蛋白（Hb）、白蛋白、前白蛋白、总蛋白等指标,以观察肠内营养对克罗恩病并发肠外瘘的治疗效果。病人肠瘘愈合后随访时间至少半年。结果    43例病人经过肠内营养治疗后，27例病人肠瘘得到愈合,平均愈合时间为（32.6±9.2）d。经治疗后所有病人的克罗恩病炎症指标血沉、CRP、Plt计数均较治疗前显著改善（P<0.05），愈合组、未愈组炎症指标改善均有显著意义（P<0.05），但两组间差异无统计学意义（P>0.05）。治疗后的营养指标如体重、BMI、Hb、白蛋白、前白蛋白、总蛋白均较治疗前显著改善（P<0.05），其中愈合组白蛋白、前白蛋白的改善情况明显优于未愈组（P<0.05）。结论    克罗恩病并发管状外瘘的病人应用肠内营养治疗后，可诱导克罗恩病缓解，减轻病人的炎症反应，改善营养状态，使部分病人的肠外瘘达到临床愈合，避免了再次手术对病人的打击。

To explore the efficacy of enteral nutrition therapy on enterocutaneous fistula of crohn’s disease        YAN Dong-sheng,REN Jian-an,HAN Gang,et al. School of Medicine; Nanjing University, Research Institute of General Surgery, Nanjing General Hospital of Nanjing Command, Nanjing 210002,China
Corresponding author: REN Jian-an，E-mail：jan@medmail.com.cn
Abstract    Objective    To investigate the efficacy of enteral nutrition (EN) therapy for Crohn’s disease (CD) complicated with tubular intestinal fistula. Methods    Clinical data of 43 enterocutaneous fistula patients of crohn’s disease treated with semi-elemental enteral nutrition  for 3 months were retrospectively analyzed from May 2007 to December 2011,in Jinling hospital. The results of whether the fistula was closed or not were recorded after EN therapy.The closure time of fistulas were also recorded too.In order to investigate the effect of EN on crohn’s fistula,we record the inflammation index (e.g. CRP、ESR、Plt) and nutritional status indicators (e.g. body weight、BMI、Hb、ALB、PALB、TP) before and after EN therapy.The follow-up time of the fistula cured patients were at least half a year. Results    27 of these 43 fistula patients were cured after EN therapy on the average of 32.6±9.2 days. Non-specific laboratory inflammation indices (ESR、CRP and Plt) of crohn’s disease were improved significantly after EN therapy when the patients were considered as a whole (P<0.05).Though the cured group and the uncured group were both much better on inflammation indices after EN therapy,there were no significant differents between the two groups (P>0.05).The nutrition status of these patients,such as body weight、BMI、Hb、ALB、PALB、TP，increased significantly after therapy compared to that before treatment (P<0.05).The fistula cured group improved much better on serum albumin and serum prealbumin than the fistula uncured group (P<0.05). Conclusions    EN therapy on enterocutaneous fistula of CD can achieve the results of induction of clinical remission, reduction of the inflammatory reaction, improvement of the nutrition status,closure of partial patientss’ fistula and avoiding the infliction of the operation.