Patterns and operative treatment of recurrent Crohn's disease: a prospective longitudinal study
Patterns and operative treatment of recurrent Crohn's disease: a prospective longitudinal study
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DOI：
10.1016/j.surg.2006.07.011
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发表时间：
2006-10-01
期刊：
影响因子：
3.8
通讯作者：
Michelassi, Fabrizio
中科院分区：
文献类型：
--
作者：
Fichera, Alessandro;Lovadina, Stefano;Michelassi, Fabrizio
背景人们普遍认为克罗恩病复发总是发生在先前肠吻合的部位;然而这种概念可能是不准确的，并且没有注意到疾病的全肠性质。在1984年10月至2003年3月期间，我们对981名连续患者进行了1132次手术（464次为原发性疾病，668次为复发性疾病）。本研究人群包括接受了初始手术和复发性疾病手术的患者。本分析排除了会阴并发症的手术操作。数据前瞻性累积。78例患者符合研究入选标准。他们共有149个疾病部位（十二指肠，n = 3;空肠/回肠，n = 53;末端回肠/新末端回肠，n = 67;结肠和直肠，n = 26）。134个部位需要手术干预（85例切除术和49例狭窄成形术），15个部位不需要手术干预。平均48.4个月（范围：1-161个月，中位数：41个月）后，克罗恩病在79个部位复发。手术介入部位和手术技术影响复发模式：当吻合或狭窄成形术用小肠构建时，大多数复发局限于肠系膜上动脉线（17/29，59%）;当吻合或狭窄成形术用小肠和结肠构建时，大多数复发延伸到近端肢体（29/35，83%）。复发模式差异有显著性（P
Background. It is believed commonly that Crohn's recurrences always occur at the site of a previous intestinal anastomosis; yet this concept is probably inaccurate and not mindful of the panintestinal nature of the disease.Materials and Methods. Between October, 1984 and March, 2003, we carried out 1, 132 procedures (464 for primary and 668 for recurrent disease) on 981 consecutive patients. Patients in whom we carried out both the original procedure as well as the procedure for recurrent disease constitute this study population. Operative procedures for perineal complications were excluded from this analysis. Data were accrued prospectively.Results. Seventy-eight patients met the study inclusion criteria. They had a total of 149 sites of disease (duodenum, n = 3; jejunum/ileum, n = 53; terminal ileum/neo terminal ileum, n = 67; colon and rectum, n = 26). One hundred thirty-four sites required operative intervention (85 resections and 49 strictureplasties) and 15 did not. Crohn's disease recurred in 79 sites after a mean of 48.4 months (range, 1-161 months, median, 41 months). Site of operative intervention and operative technique influenced patterns of recurrence: when an anastomosis or strictureplasty was constructed with small bowel, the majority of recurrences were limited to the anastomatic line (17/29, 59 %); when it was constructed with small bowel and colon, the majority of recurrences extended to the proximal limb (29/35, 83 %). The difference in recurrence pattern is significant (P