Patterns of postoperative recurrence in Crohn's disease.
Patterns of postoperative recurrence in Crohn's disease.
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克罗恩病术后复发的模式。
DOI：
10.3109/00365529009091907
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发表时间：
1990
期刊：
影响因子：
--
通讯作者：
D. B. Sachar
中科院分区：
文献类型：
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作者：
D. B. Sachar
克罗恩病治疗中最困难的问题是该病是永久性的且无法治愈。尽管大多数患者最终进行了切除手术并因此得到了很大改善，但大多数情况下疾病在手术后几年内复发。这种术后复发现象几十年来一直被人们所认识，但对于复发性疾病的频率、发生率和危险因素等重要问题却几乎没有达成一致。分歧的原因主要是方法论上的，分为三大类：1）复发的定义不同； 2）操作流程不同； 3）不同的统计方法。有两个因素似乎对术后复发率影响最大。一是外科手术本身，吻合术后比回肠造口术后复发更快、更频繁。第二个也许更重要的因素是潜在疾病的行为。数据表明，侵袭性瘘管形式的克罗恩病使患者更快接受手术，术后复发和再次手术的速度也更快；这种疾病也容易复发，并伴有与原来相似的瘘管并发症。相比之下，惰性更强的阻塞性克罗恩病会导致患者较晚进行手术，并且复发和再次手术的速度也会较慢。这种疾病往往会复发并伴有阻塞性并发症。对克罗恩病这两种不同临床形式的认识可能具有重要的预后甚至病理生理学意义。
The most difficult problem in the management of Crohn's disease is that the condition is permanent and incurable. Even though most patients ultimately have resection surgery and are thereby greatly improved, in most cases the disease recurs within several years after the operation. This phenomenon of postoperative recurrence has been recognized for decades, yet there has been little agreement concerning such important issues as the frequency, rate, and risk factors of recurrent disease. The reasons for disagreement are primarily methodologic and fall into three major categories: 1) different definitions of recurrence; 2) different operative procedures; and 3) different statistical methods. Two factors in particular seem to exert the strongest influence on the rates of postoperative recurrence. One is the surgical procedure itself, with recurrences appearing faster and more frequently after anastomoses than after ileostomies. The second and perhaps more important factor is the behavior of the underlying disease. Data suggest that an aggressive fistulizing form of Crohn's disease brings patients to surgery sooner and is followed by a faster rate of postoperative recurrence and reoperation; the disease also tends to recur with fistulous complications similar to the original ones. By contrast, a more indolent obstructing form of Crohn's disease brings patients to surgery later and is followed by a slower rate of recurrence and reoperation; this form of disease tends to recur with obstructive complications. The recognition of these two different clinical forms of Crohn's disease may have important prognostic and even pathophysiologic implications.