单中心1048例克罗恩病手术患者临床特点及预后分析

Characteristics and predictors of postoperative outcome of Crohn disease patients requiring abdominal surgery:a series of 1048 cases from a single inflammatory bowel disease centre

目的探讨克罗恩病手术患者的临床特点、术后并发症相关因素和术后需手术干预复发的预后因素。方法回顾性分析2007年1月至2017年12月在东部战区总医院普通外科接受手术治疗的克罗恩病患者的临床资料,分析患者的蒙特利尔分型、手术指征、手术所见及手术方式等,采用Logistic回归分析术后并发症的相关因素,采用Cox比例风险模型分析术后需手术干预复发的预后因素。结果纳入符合条件的克罗恩病患者1048例,男性733例,女性315例。患者共接受手术治疗1513次,初次腹部手术时的中位年龄为31(17)岁,初次手术切除的小肠长度为30.0(40.0)cm。穿透型病变(OR=8.594,95%CI:3.397~21.740,P<0.01)和正在吸烟(OR=2.671,95%CI:1.044~6.832,P=0.040)是首次手术后腹腔感染性并发症相关因素,而分期手术(OR=0.360;95%CI:0.184~0.707,P=0.003)是保护性因素。男性(HR=1.500,95%CI:1.128~1.995,P=0.005),上消化道疾病(HR=1.526,95%CI:1.033~2.255,P=0.034),穿透型病变(HR=1.506,95%CI:1.132~2.003,P=0.005)和急诊手术(HR=1.812,95%CI:1.375~2.387,P<0.01)是首次手术后需手术干预复发的预后因素,分期手术较同期手术可降低该复发风险(HR=0.361,95%CI:0.227~0.574,P<0.01)。结论本组克罗恩病患者初次手术的中位年龄为31岁,切除小肠中位长度为30 cm。穿透型病变与术后感染性并发症和需手术干预复发相关,分期手术可能对术后并发症高风险患者产生近期和远期的获益。

Objective To examine the clinical characteristics,the potential relative factors for postoperative abdominal septic complications,and prognosis factors of surgical recurrence of Crohn disease(CD)patients after the first surgery.Methods All the CD patients from Department of General Surgery,Jinling Hospital,Medical School of Nanjing University who had undergone at least one abdominal surgery from January 2007 to December 2017 were included for retrospective analysis.Hospital records were reviewed for information on clinical characteristics.Relative factors of postoperative abdominal septic complications were accessed by Logistic regression models,and prognosis factors of surgical recurrence were accessed by Cox proportional hazards regression models.Results There were 1048 patients included(733 males and 315 females),accounting for 1513 operations.The age was 31(17)years and the length of resected small bowel was 30.0(40.0)cm at the first resection,20.0(35.0)cm at the second resection,and 20.0(23.5)cm at the third resection.The length of resected small bowel was 25.0(40.0)cm at any resection.At the first abdominal surgery,70.99%(744/1048)patients were aged between 17 and 40 years,66.98%(702/1048)patients had ileocolonic disease,and 60.40%(633/1048)patients had penetrating behavior.Penetrating behavior(OR=8.594,95%CI:3.397 to 21.740,P<0.01)and current smoking status(OR=2.671,95%CI:1.044 to 6.832,P=0.040)were significantly associated with an increased risk of postoperative septic complications,whereas staged operation(OR=0.360,95%CI:0.184 to 0.707,P=0.003)was associated with a decreased risk.Male gender(HR=1.500,95%CI:1.128 to 1.995,P=0.005),upper gastrointestinal disease(HR=1.526,95%CI:1.033 to 2.255,P=0.034),penetrating behavior(HR=1.506,95%CI:1.132 to 2.003,P=0.005)and emergency surgery(HR=1.812,95%CI:1.375 to 2.387,P<0.01)were significantly associated with an increased risk of postoperative surgical recurrence,whereas staged operation(HR=0.361,95%CI:0.227 to 0.574,P<0.01)was significantly associated with a decreased risk.Conclusions In this cohort of CD patients receiving abdominal surgery from an inflammatory bowel disease center,the median age was 31 years and the median length of resected small bowel was 30 cm,at first resection.Patients who have risk factors of adverse postoperative outcome may be benefited from staged surgical approach.