Intraabdominal septic complications following bowel resection for Crohn's disease: detrimental influence on long-term outcome
Intraabdominal septic complications following bowel resection for Crohn's disease: detrimental influence on long-term outcome
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DOI：
10.1007/s00384-008-0534-9
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发表时间：
2008-12-01
影响因子：
2.8
通讯作者：
Agha, Ayman
中科院分区：
文献类型：
--
作者：
Iesalnieks, Igors;Kilger, Alexandra;Agha, Ayman
许多研究涉及影响术后复发的因素;然而，它们没有分析术后发病率对长期结局的影响。这是本研究的目的，在1992年至2005年期间，282例原发性或复发性克罗恩病患者接受了331次肠切除术。排除了回肠造口或结肠造口闭合、孤立性狭窄成形术、肛周疾病的腹会阴切除术和术后并发症的再次手术。手术复发是指由于狭窄或穿孔性疾病的发展而需要再次手术治疗。46例（16%）手术后发生吻合口漏、腹腔脓肿、肠外瘘（腹腔内脓毒症并发症，IASC）。4例患者死亡（1.2%）。通过多变量分析，关节疾病表现（p = 0.03）、导致手术的症状持续时间（p = 0.009）和体重减轻（p = 0.03）与术后并发症的发生相关。手术复发发生在86例肠切除术后，36例发生在术后第一年。通过多变量分析，以下因素与手术复发风险增加相关：术后IASC（p = 0.0002）和既往肠切除术（p = 0.002）。IASC患者1、2、5和10年的手术复发率（25%、29%、50%和57%）显著高于非IASC患者（4%、7%、19%和38%，p = 0.0003）。术后IASC的发生率主要取决于术前疾病严重程度。IASC对克罗恩病患者肠切除术后的长期结局有不利影响，导致重复切除手术的数量增加。
A number of studies deal with factors affecting postoperative recurrence; however, they do not analyze the influence of postoperative morbidity on the long-term outcome. This was the aim of the present study.Two hundred eighty-two patients underwent 331 intestinal resections for primary or recurrent Crohn's disease between 1992 and 2005. Closure of ileostomy or colostomy, isolated stricturoplasty, abdominoperineal resection for perianal disease, and reoperations for postoperative complications were excluded. "Surgical recurrence" was defined as a development of stricturing or perforating disease necessitating repeat surgical therapy.Anastomotic leak, intraabdominal abscess, enterocutaneous fistula (intraabdominal septic complications, IASC) occurred after 46 operations (16%). Four patients died (1.2%). By multivariate analysis, articular disease manifestation (p = 0.03), duration of symptoms leading to surgery (p = 0.009), and weight loss (p = 0.03) were associated with occurrence of postoperative complications. Surgical recurrence occurred following 86 bowel resections, and 36 occurred during the first postoperative year. The following factors were associated with an increased risk of surgical recurrence by multivariate analysis: postoperative IASC (p = 0.0002) and previous bowel resections (p = 0.002). Patients suffering IASC had statistically significantly higher 1-, 2-, 5-, and 10-year surgical recurrence rate (25%, 29%, 50%, and 57%) than patients without IASC (4%, 7%, 19%, and 38%, p = 0.0003).The incidence of the postoperative IASC is predominantly determined by preoperative disease severity. IASC have a detrimental influence on the long-term outcome following intestinal resections in patients with Crohn's disease, leading to increased number of repeat resection surgery.