Evaluation of preoperative predictors of development of pouchitis after ileal-pouch-anastomosis in ulcerative colitis
Evaluation of preoperative predictors of development of pouchitis after ileal-pouch-anastomosis in ulcerative colitis
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DOI：
10.1016/j.clinre.2012.04.012
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发表时间：
2012-12-01
影响因子：
2.7
通讯作者：
Ulker, A.
中科院分区：
文献类型：
--
作者：
Kalkan, I. H.;Dagli, U.;Ulker, A.
引言：在本回顾性研究中，我们旨在评估接受 Heal 储袋肛管吻合术（IPAA）的溃疡性结肠炎（UC）患者发生储袋炎的术前预测危险因素。方法：检索 1994 年 1 月至 2009 年 9 月期间在我院炎症性肠病（IBD）门诊接受 IPAA 手术并随访的 UC 患者的记录。记录术前临床、生化和内镜检查结果，以及术前内镜活动指数（EAI）、术前疾病活动指数（DAI）和手术特征。确定了内镜、组织学和临床表现与储袋炎一致的患者。结果：在 49 名接受 IPAA 治疗 UC 的患者中，其中 20 名 (40.8%) 发现储袋炎。总体而言，37 名患者（75.5%）患有慢性活动性疾病，8 名患者（16.3%）患有频繁复发的慢性间歇性疾病，4 名患者（8.2%）在手术前患有暴发性结肠炎。这些患者术后发生储袋炎的情况存在统计学显着性差异（P = 0.02）。储袋炎患者的平均 EAI（10.1 vs. 8.7，P = 0.02）和 DAI（10.0 vs. 8.6，P < 0.01）显着高于未发生储袋炎的患者。多变量分析显示，类固醇依赖性（P = 0.02）和较高的 DAI（P = 0.02）是发生储袋炎的独立危险因素。 结论：更严重的术前临床病程和类固醇依赖性，以及更高的内镜和疾病活动评分可能是接受 IPAA 手术的 UC 患者后续储袋炎的术前预测因素。 (c) 2012 年 Elsevier Masson SAS。版权所有。
Introduction: In this retrospective study, we aimed to evaluate preoperative predictive risk factors for development of pouchitis in the ulcerative colitis (UC) patients with Heal pouch-anal anastomosis (IPAA).Methods: The records of UC patients who underwent IPAA surgery and were under follow-up in the inflammatory bowel disease (IBD) clinic of our hospital between January 1994 and September 2009 were retrieved. Preoperative clinical, biochemical, and endoscopic findings, as well as preoperative endoscopic activity index (EAI), preoperative disease activity index (DAI) and operative characteristics were recorded. Patients with endoscopic, histological and clinical findings consistent with pouchitis were identified.Results: Out of a total of 49 patients who underwent IPAA for UC, pouchitis was identified in 20 (40.8%) of them. Overall, 37 (75.5%) patients had chronic active disease, eight (16.3%) patients had chronic intermittent disease with frequent relapses, and four (8.2%) patients had fulminant colitis prior to surgery. There was a statistically significant difference (P = 0.02) among these patients for the development of pouchitis in postoperative period. The mean EAI (10.1 vs. 8.7, P = 0.02) and DAI (10.0 vs. 8.6, P < 0.01) in patients with pouchitis were significantly higher than that of patients who did not develop pouchitis. Multivariate analysis revealed steroid dependency (P = 0.02), and a higher DAI (P = 0.02) to be independent risk factors for the development of pouchitis.Conclusion: A more severe preoperative clinical course and steroid dependency, as well as higher endoscopic and disease activity scores may be useful as preoperative predictors of subsequent pouchitis in UC patients undergoing IPAA surgery. (c) 2012 Elsevier Masson SAS. All rights reserved.