肠部分切除后吻合方式对克罗恩病术后复发的影响

Impact of anastomosis type on postoperative recurrence after bowel resection for Crohn disease

目的探讨克罗恩病（CD）患者实施肠切除肠吻合手术后，吻合方式对CD术后复发的影响。方法回顾性分析2002年1月至2010年1月在南京军区南京总医院行肠切除肠吻合术的94例CD患者的临床资料，比较实施侧侧吻合（SSA组，56例）与端侧或端端吻合（非SSA组，38例）两组患者的术后内镜复发和临床复发情况。结果SSA组和非SSA组术后1年和2年累计内镜复发率分别为10．7％、46．4％和29．2％、66．7％，差异有统计学意义（P=0．037）：两组术后1年和2年累计临床复发率分别为3．6％、8．9％和7．9％、21．1％，差异亦有统计学意义（P=0．041）。结论相对于端端和端侧吻合．CD患者在实施肠切除时行侧侧吻合能显著降低术后复发率：侧侧吻合可考虑作为CD肠切除后的首选吻合方式。

Objective To determine whether side-to-side anastomosis （SSA） is associated with decreased recurrence after bowel resection for Crohn disease （CD） as compared to end-to-side anastomosis （ESA） or end-to-end anastomosis （EEA）. Methods Patients undergoing bowel resection for CD at the Jinling hospital of Nanjing University School of Medicine from 2002 to 2010 were studied retrospectively. Postoperative recurrence in patients with SSA was compared with that in patients with ESA or EEA. Results A total of 94 patients underwent bowel resection for CD. Anastomosis type was SSA in 56 patients and ESA or EEA in 38. Postoperatively 52 patients underwent at least one endoscopic evaluation （28 SSA and 24 ESA or EEA）. The postoperative cumulative endoscopic recurrence rate was 10.7% at 1 year and 46.4% at 2 years in the SSA group, and was 29.2% at 1 year and 66.7% at 2 year in the ESA/EEA group, the differences were statistically significant （Log-rank P=0.037）. The postoperative cumulative clinical recurrence rate was 3.6% at 1 year and 8.9% at 2 years in the SSA group, and was 7.9% at 1 year and 21.1% at 2 year in the ESA/EEA group, the differences were statistically significant （Log-rank P=0.041）. Conclusion Side-to-side anastomosis is associated with decreased symptomatic recurrence and endoscopic recurrence as compared to ESA or EEA.