摘要
目的探讨回结肠型克罗恩病手术相关并发症及危险因素。方法采用回顾性病例对照研究方法。收集2010年1月至2016年4月北京协和医院收治的52例行手术治疗的回结肠型克罗恩病患者的临床病理资料。观察指标：（1）手术相关并发症情况。（2）手术相关并发症危险因素分析：性别、发病年龄、术前BMI、病程、吸烟史、阑尾手术史、肛周病变、口腔溃疡、c反应蛋白、血沉、疾病行为、简化克罗恩病疾病活动指数（sCDAI）评分、术前氨基水杨酸治疗、术前激素治疗、术前抗结核治疗、术前免疫抑制剂治疗、术前生物制剂治疗、急诊手术、手术方式、回结肠吻合方式。（3）随访情况。采用门诊和电话方式进行随访，了解患者疾病复发情况。随访时间截至2016年8月。正态分布的计量资料以x±s表示。单因素分析采用Ⅳ。检验，多因素分析采用Logistic回归模型。结果（1）手术相关并发症情况：52例患者中，12例发生术后并发症，包括切口感染4例，经清创、换药后切口愈合良好；腹腔感染4例，其中3例经抗感染对症治疗后好转，1例因感染性休克术后1d死亡；肠梗阻1例，行剖腹粘连松解术后恢复良好；肠瘘1例，因病情危重，家属自动要求出院；急性胆囊炎1例，经保守治疗后好转；术后急性胰腺炎1例，经保守治疗后恢复良好。（2）手术相关并发症危险因素分析：单因素分析结果显示：sCDAI评分、急诊手术是影响回结肠型克罗恩病手术相关并发症发生的因素（r=6．299，8．494，P〈0．05）。多因素分析结果显示：sCDAI评分是影响回结肠型克罗恩病手术相关并发症发生的独立因素（OR=2．716，95％可信区间：1．216—6．066，P〈0．05）。（3）随访情况：52例患者均获得术后随访，随访时间为5—76个月，中位随访时间为39个月。随访期间，15例患者疾病复发，予以相应内科治疗。结论活动期回结肠型克罗恩病患者术后较易发生切口和腹腔感染，sCDAI评分是影响回结肠型克罗恩病手术相关并发症发生的独立因素。
Objective To investigate the surgery-related complications and risk factors of ileoeolic Crohn＇s disease （CD）. Methods The retrospective case-control study was conducted. The clinicopathological data of 52 patients with ileoeolic CD who underwent surgery at the Peking Union Medieal College Hospital from January 2010 to April 2016 were collected. Observation indicators ： （ 1 ） surgery-related complications, （2） risk factors analysis of surgery-related complications： gender, age of onset, preoperative body mass index （BMI） , course of disease, smoking history, history of appendectomy, perianal lesions, oral ulcer, C-reactive protein （ CRP）, erythrocyte sedimentation rate, disease behavior, short crohn＇s disease activity index （sCDAI）, preoperative amino salicylic acid therapy, preoperative hormone therapy, preoperative antitubereulosis therapy, preoperative immunosup- pressive agents therapy, preoperative biologic agents therapy, emergency operation, surgical method and ileoeolie anastomosis method, （3） follow-up. The follow-up using outpatient examination and telephone interview was performed to detect recurrence of disease up to August 2016. Measurement data with normal distribution were represented as x ± s. The univariate analysis was done using the ehi-square test, and multivariate analysis was done using the Logistic regression model. Results （ 1 ） Surgery-related complications ： of 52 patients, 12 had postoperative complications. Four patients complicated with wound infection had good healing of the wound after debridement and dressing change. Of 4 patients with abdominal infection, 3 were improved by anti-infection symptomatic treatment and 1 die of septic shock at postoperative day 1. One patient with intestinal obstruction had a smooth recovery after open adhesiolysis. One patient with intestinal fistula discharged from hospital due to a critical condition under families＇ requestion. One patient with acute cholecystitis and 1 with acute pancreatitis were respectively improved by conservative treatment. （2） Risk factors analysis of surgery-related complications： the result of univariate analysis showed that sCDAI and emergency operation were the factors infecting surgery-related complications of ileocolic CD （X2 = 6. 299, 8. 494, P 〈 0.05 ）. The result of multivariate analysis showed that sCDAI was an independent factor infecting surgery-related complications of ileocolic CD [ OR = 2. 716, 95% confidence interval （CI） ： 1. 216- 6. 066, P 〈 0.05 ]. （3） Follow-up ： all the 52 patients were followed up for 5- 76 months with a median time of 39 months. During the follow-up, 15 had recurrence of diseases and then underwent medical treatment. Conclusions Patients with ileocolic CD are easily complicated with wound infection and abdominal infection in the active period, and sCDAI is an independent factor infecting surgery-related complications of ileocolic CD.
出处
《中华消化外科杂志》
CAS
CSCD
北大核心
2016年第12期1165-1169,共5页
Chinese Journal of Digestive Surgery
基金
国家自然科学基金（81570505）
关键词
克罗恩病
回结肠
外科手术
并发症
危险因素
Crohn＇s disease, ileocolic
Surgical procedures, operative
Complications
Risk factors
