Safety and longterm efficacy of strictureplasty in 314 patients with obstructing small bowel Crohn's disease
Safety and longterm efficacy of strictureplasty in 314 patients with obstructing small bowel Crohn's disease
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DOI：
10.1016/s1072-7515(01)00775-x
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发表时间：
2001-03-01
影响因子：
5.2
通讯作者：
Fazio, VW
中科院分区：
文献类型：
--
作者：
Dietz, DW;Laureti, S;Fazio, VW
背景技术背景：自20世纪80年代初引入以来，狭窄成形术（SXP）已成为梗阻性小肠克罗恩病外科治疗的可行选择。与切除术相比，其安全性和长期耐用性仍然存在问题。精确的适应症和禁忌症的程序也没有很好地defined.Study设计：一个回顾性审查的所有患者接受SXP阻塞小肠克罗恩病在克利夫兰诊所1984年和1999年之间进行。共有314例患者接受了包括索引SXP的剖腹手术。进行的SXP总数为1，124，每例患者的中位数为2（范围1至19）。66%的患者接受了同步肠切除术。复发定义为需要再次手术。随访信息由个人访谈，电话采访，或both.RESULTS：总体发病率为18%，脓毒性并发症发生在5%的患者。发现术前体重减轻（p = 0.004）和年龄较大（p = 0.008）是发病率的重要预测因素。手术复发率为34%，中位随访期为7.5年（范围1至16年）。年龄被认为是一个显着的预测复发（p = 0.02），与年轻的患者有一个较短的时间再operation.CONCLUSIONS：这一大系列的患者长期随访证实了狭窄成形术的安全性和有效性，阻塞性小肠克罗恩病的患者。18%的发病率和34%的手术复发率与切除手术的报告结果相比是有利的。术前体重减轻的患者应谨慎使用，因为他们的并发症发生率较高。尽管年轻患者似乎遵循加速过程，但SXP仍然适用于保护肠道长度的整体策略的一部分。（美国科尔外科杂志2001;192：330-338。(C)2001年由美国外科医生学会出版）。
BACKGROUND: Since its introduction in the early 1980s, strictureplasty (SXP) has become a viable option in the surgical management of obstructing small bowel Crohn's disease. Questions still remain regarding its safety and longterm durability in comparison to resection. Precise indications and contraindications to the procedure are also not well defined.STUDY DESIGN: A retrospective review of all patients undergoing SXP for obstructing small bowel Crohn's disease at the Cleveland Clinic between 1984 and 1999 was conducted. A total of 314 patients underwent a laparotomy that included the index SXP. The total number of SXPs performed was 1,124, with a median of two (range 1 to 19) per patient. Sixty-six percent of patients underwent a synchronous bowel resection. Recurrence was defined as the need for reoperation. Followup information was determined by personal interviews, phone interviews, or both.RESULTS: The overall morbidity rate was 18%, with septic complications occurring in 5% of patients. Preoperative weight loss (p = 0.004) and older age (p = 0.008) were found to be significant predictors of morbidity. The surgical recurrence rate was 34%, with a median followup period of 7.5 years (range 1 to 16 years). Age was found to be a significant predictor of recurrence (p = 0.02), with younger patients having a shorter time to reoperation.CONCLUSIONS: This large series of patients with longterm followup confirms the safety and efficacy of strictureplasty in patients with obstructing small bowel Crohn's disease. The 18% morbidity and 34% operative recurrence rates compare favorably with reported results of resective surgery. Caution should be used in patients with preoperative weight loss, because they experienced higher complication rates. Although young patients seem to follow an accelerated course, SXP remains indicated as part of an overall strategy to conserve intestinal length. (J Am Coll Surg 2001;192:330-338. (C) 2001 by the American College of Surgeons).