摘要
目的探讨克罗恩病患者行回结肠切除术后复发的影响因素。方法回顾性分析2011年7月至2020年3月浙江大学医学院附属邵逸夫医院普外科收治的86例克罗恩病行单纯回结肠切除术且无残余病灶患者的临床资料,分析术后复发情况,采用多因素Logistic回归分析探讨术后复发的独立危险因素。结果86例患者中位病程24(8,48)个月,其中40例合并肛周病变,手术原因为狭窄性病变53例、穿透性病变26例、药物保守治疗无效7例。86例患者中41例(47.7%)术后使用药物预防复发(22例服用硫唑嘌呤,53.7%),其中有28例(68.3%)出现内镜复发,13例(31.7%)未出现内镜复发;45例(52.3%)术后未使用药物预防复发,其中19例(42.2%)出现内镜复发,26例(57.8%)未出现内镜复发。86例患者术后随访时间6~110个月,中位随访时间37.0(26.0,63.5)个月,期间术后内镜复发共47例(54.7%),包括吻合口复发20例、非吻合口复发9例、吻合口及非吻合口同时复发18例,其中4例(8.5%)最终出现外科复发予再手术治疗,其余予以药物控制。多因素Logistic分析显示穿透性病变以及低骨骼肌指数是克罗恩病术后内镜复发的独立危险因素。结论克罗恩病行回结肠切除术且无残余病灶的患者,如术前合并穿透性病变或低骨骼肌指数,术后复发风险高,需密切随访并及时调整用药控制疾病活动。
Objectives To investigate the risk factors for recurrence in patients with Crohn’s disease after laparoscopic ileoce⁃cal resection.Methods This was a retrospective analysis of 86 patients with Crohn’s disease who underwent laparoscopic ileoce⁃cal resection with no residual lesions between July 2011 and March 2020 at the Department of General Surgery,Sir Run Run Shaw Hospital,Medical School of Zhejiang University.Postoperative recurrence was recorded.Multivariate Logistic regression anal⁃ysis were used to investigate independent risk factors for postoperative recurrence.Results Median(QL,QU)disease duration of the 86 patients was 24(8,48)months.Forty patients had concomitant anal lesions.Indications for surgery were stricture(n=53),perforation(n=26),failure of conservative medical treatment(n=7).Forty-one(47.7%)patients received postoperative prophylactic medications to prevent recurrence,22(53.7%)of whom received azathioprine.Among these 41 patients,28(68.3%)had recurrence,while 13(31.7%)did not have recurrence by laparoscopic examination.Forty-five(52.3%)patients did not receive prophylactic medications to prevent recurrence.Among these 45 patients,19(42.2%)had recurrence,while 26(57.8%)did not have recurrence.Patients were followed up for 6 to 110 months with a median(QL,QU)of 37.0(26.0,63.5)months.A total of 47(54.7%)patients experienced recurrences,including 20 anastomotic recurrences,9 non-anastomotic recurrences,and 18 both anastomotic and non-anastomotic recurrences.All recurrence was managed with medications except in four(8.5%)patients who had re-sur⁃gery due to recurrence.Multivariate Logistic regression analysis showed that perforation and low skeletal muscle index were inde⁃pendent risk factors for recurrence after surgery for Crohn’s disease.Conclusion In patients with Crohn’s disease after laparo⁃scopic ileocecal resection,the recurrence risk is high in patients with perforation and low skeletal muscle index.Close follow-up and timely adjustment of medications are needed for these patients to control the risk of recurrence.
作者
葛晓龙
吴燕
刘威
戚卫林
徐海利
周伟
Ge Xiaolong;Wu Yan;Liu Wei;Qi Weilin;Xu Haili;Zhou Wei(Department of General Surgery,Sir Run Run Shaw Hospital,Medical School of Zhejiang University,Hangzhou 310016,Zhejiang,China)
出处
《结直肠肛门外科》
2020年第6期669-673,678,共6页
Journal of Colorectal & Anal Surgery
关键词
克罗恩病
回结肠切除
复发
Crohn’s disease
ileocecal resection
recurrence
