Surgical recurrence in Crohn's disease: a comparison between different types of bowel resections
Surgical recurrence in Crohn's disease: a comparison between different types of bowel resections
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DOI：
10.1007/s00384-018-2995-9
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发表时间：
2018-04-01
影响因子：
2.8
通讯作者：
Lepisto, Anna
中科院分区：
文献类型：
--
作者：
Aaltonen, Gisele;Carpelan-Holmstrom, Monika;Lepisto, Anna
比较克罗恩病患者不同类型肠切除术的复发频率和位置。这是一项回顾性研究，研究对象为2006年至2016年间因克罗恩病接受肠切除术的连续患者。记录初次手术类型，并将其分组为回结肠切除术、小肠切除术、节段性结肠切除结肠吻合术或结直肠吻合术、结肠切除回肠直肠吻合术或末端吻合术。使用二元逻辑回归比较两组之间的手术复发频率。我们还调查了克罗恩病再次手术的部位与原发性肠切除术类型的关系，共有218例患者纳入我们的研究，平均随访时间为4.7年。42例（19.3%）患者接受了再次手术。使用回结肠切除术组作为参考的再手术风险如下：小肠切除术（比值比（OR）2.95，95%置信区间（CI）1.01-8.66; P = 0.049），节段性结肠切除联合结肠或结肠直肠吻合术（OR 6.20，95% CI 2.04-18.87; P = 0.001），结肠切除回肠直肠吻合术（OR 26.57，95% CI 2.59-273.01; P = 0.006）和吻合口末端手术（OR 4.62，95% CI 1.90-11.26; P = 0.001）。在手术复发的情况下，再手术的类型和位置与原发性肠切除术的类型相关。回结肠切除术后克罗恩病的再手术频率低于其他类型的肠切除术后。克罗恩病的手术复发倾向于维持初次手术的疾病部位。三分之一的克罗恩病患者接受终末造口手术仍将需要新的肠切除术，由于复发。
To compare recurrence frequency and location between different types of bowel resections in Crohn's disease patients.This was a retrospective study of consecutive patients undergoing bowel resection for Crohn's disease between 2006 and 2016. Type of primary operation was recorded and grouped as ileocolic resection, small bowel resection, segmental colon resection with colocolic anastomosis or colorectal anastomosis, colectomy with ileorectal anastomosis, or end stoma operation. Binary logistic regression was used to compare surgical recurrence frequency between groups. We also investigated how Crohn's disease location at reoperations was related to the primary bowel resection type.Altogether, 218 patients with a median follow-up of 4.7 years were included in our study. Reoperation was performed in 42 (19.3%) patients. The risk of reoperation using the ileocolic resection group as reference was the following: small bowel resection (odds ratio (OR) 2.95, 95% confidence interval (CI) 1.01-8.66; P = 0.049), segmental colon resection with colocolic or colorectal anastomosis (OR 6.20, 95% CI 2.04-18.87; P = 0.001), colectomy with ileorectal anastomosis (OR 26.57, 95% CI 2.59-273.01; P = 0.006), and end stoma operation (OR 4.62, 95% CI 1.90-11.26; P = 0.001). In case of surgical recurrence, the reoperation type and location correlated with the primary bowel resection type.Reoperation frequency in Crohn's disease is lower after ileocolic resection than after other types of bowel resections. Surgical recurrence in Crohn's disease tends to maintain the disease location of the primary operation. One third of Crohn's patients undergoing an end stoma operation will still need new bowel resections due to recurrence.