Risk factors for intra-abdominal septic complications after a first ileocecal resection for Crohn's disease: A multivariate analysis in 161 consecutive patients
Risk factors for intra-abdominal septic complications after a first ileocecal resection for Crohn's disease: A multivariate analysis in 161 consecutive patients
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DOI：
10.1007/s10350-006-0782-0
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发表时间：
2007-03-01
影响因子：
3.9
通讯作者：
Valleur, Patrice
中科院分区：
文献类型：
--
作者：
Alves, Arnaud;Panis, Yves;Valleur, Patrice
目得：本研究旨在评估克罗恩病患者回盲部切除术后腹腔内脓毒症并发症的预测因素。方法：采用正交设计法从1984年至2004年，连续161例克罗恩病患者（81名男性，平均年龄，3 3 +/- 10岁）进行了，作为第一次手术，选择性回盲部切除术没有临时造口。术后，15名患者（9%）发生了腹部脓毒性并发症，包括脓肿和吻合口漏。采用单因素和多因素分析方法分析术后腹腔内感染并发症的可能影响因素。结果：无术后死亡。多变量分析发现，只有四个独立因素与术后腹腔内脓毒症并发症的风险较高相关：营养状况不良（比值比，6.23（1.75-22.52）），术中发现腹腔脓肿（比值比，7.47（1.5-37.69）），术前使用类固醇超过3个月（比值比，5.95（1.04-34.1））和克罗恩病复发性临床发作（比值比（每次发作），1.38（1.03-1.9））。结论：克罗恩病的复发性临床发作、术前使用类固醇、营养状况差和手术时存在脓肿显著增加了克罗恩病首次回盲部切除术后脓毒性腹部并发症的风险。了解这些风险因素可以允许在非常高风险的患者中提出临时造口（即，3个或更多的风险因素）。
PURPOSE: This study was designed to assess predictive factors of postoperative intra-abdominal septic complication in a homogenous group of patients undergoing ileocecal resection for Crohn's disease. METHODS: From 1984 to 2004, 161 consecutive patients with Crohn's disease (81 males; mean age, 3 3 +/- 10 years) underwent, as a first operation, an elective ileocecal resection without temporary stoma. Postoperatively, 15 patients (9 percent) developed abdominal septic complications, including abscess and anastomotic leaks. Possible factors for postoperative intra-abdominal septic complication were analyzed by both univariate and multivariate analyses. RESULTS: There was no postoperative death. Multivariate analysis found only four independent factors associated with a higher risk of postoperative intra-abdominal septic complication: poor nutritional status (odds ratio, 6.23 (1.75-22.52)), intraabdominal abscess discovered during surgery (odds ratio, 7.47 (1.5-37.69)), preoperative steroids use more than three months (odds ratio, 5.95 (1.04-34.1)), and recurrent clinical episode of Crohn's disease (odds ratio (per episode), 1.38 (1.03-1.9)). CONCLUSIONS: Recurrent clinical episode of Crohn's disease, preoperative steroids use, poor nutritional status, and the presence of abscess at the time of surgery significantly increased the risk of septic abdominal complications after first ileocecal resection for Crohn's disease. Knowledge of these risk factors could permit to propose a temporary stoma in very high-risk patients (i.e., with 3 or more risk factors).