Trends in the Surgical Management of Crohn's Disease
Trends in the Surgical Management of Crohn's Disease
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DOI：
10.1007/s11605-015-2911-3
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发表时间：
2015-10-01
影响因子：
3.2
通讯作者：
Tsikitis, Vassiliki L.
中科院分区：
文献类型：
--
作者：
Geltzeiler, Cristina B.;Hart, Kyle D.;Tsikitis, Vassiliki L.
尽管近年来克罗恩病的医学治疗发生了变化，但尚不清楚手术治疗是否发生了变化。我们检查了手术干预率的变化，造口建设，回肠造口术和结肠造口术的建设子集。我们回顾了全国住院病人样本数据库从1988年到2011年。我们检查了克罗恩病相关手术和造口的数量，包括回肠造口和结肠造口;建立了多变量logistic回归模型，共分析了355，239例克罗恩病相关手术。手术从1988年的13，955例增加到2011年的17，577例，p < 0.001。造口结构从2493增加到4283，p < 0.001。回肠造口的子集从1201增加到3169，p < 0.001，而结肠造口从1351减少到1201，p = 0.05。导致造口构建的手术百分比从18%增加到24%，p < 0.001。体重减轻（OR 2.25，95%CI 1.88，2.69）和肛周瘘管病（OR 2.91，95%CI 2.31，3.67）是需要造口的最佳预测因素。造口构建的最大预测因素是体重减轻和肛周瘘管病。因此，应优化营养，并应考虑多学科小组的早期参与。
Although medical management of Crohn's disease has changed in recent years, it is unclear whether surgical management has altered. We examined rate changes of surgical interventions, stoma constructions, and subset of ileostomy and colostomy constructions.We reviewed the Nationwide Inpatient Sample database from 1988 to 2011. We examined the number of Crohn's-related operations and stoma constructions, including ileostomies and colostomies; a multivariable logistic regression model was developed.A total of 355,239 Crohn's-related operations were analyzed. Operations increased from 13,955 in 1988 to 17,577 in 2011, p < 0.001. Stoma construction increased from 2493 to 4283, p < 0.001. The subset of ileostomies increased from 1201 to 3169, p < 0.001 while colostomies decreased from 1351 to 1201, p = 0.05. Operation percentages resulting in stoma construction increased from 18 to 24 %, p < 0.001. Weight loss (OR 2.25, 95 % CI 1.88, 2.69) and presence of perianal fistulizing disease (OR 2.91, 95 % CI 2.31, 3.67) were most predictive for requiring stoma construction.Crohn's-related surgical interventions and stoma constructions have increased. The largest predictors for stoma construction are weight loss and perianal fistulizing disease. As a result, nutrition should be optimized and the early involvement of a multidisciplinary team should be considered.