摘要
背景:本研究旨在分析克罗恩病患者回结肠切除术后近期并发症的发生率及危险因素。方法:对PRACTICROHN研究队列进行回顾性分析,纳入2007年1月至2010年12月间行回结肠切除一期吻合的成人克罗恩病患者。术后近期并发症定义为术后30天内出现的并发症,包括死亡、肠梗阻、吻合口漏、消化道出血、腹腔脓肿、切口感染、导管相关感染及其他腹腔外感染。结果:364例患者纳入分析,手术时患者的中位年龄38岁,男性占50%。手术适应证:狭窄型占46.4%,穿透型占31.3%,狭窄+穿透型占14.0%,药物难治性占5.8%。100例(27.5%)出现术后近期并发症,其中切口感染、腹腔脓肿和吻合口漏最为常见。出现并发症的患者其中位住院时间较未出现并发症者显著延长(16 vs 9天,P<0.001)。术后并发症更多发生于穿透型病变(36/114,31.6%)和药物难治性(9/21,42.9%)患者,而狭窄型(45/169,26.6%)和狭窄+穿透型(6/51,11.8%)患者并发症发生率相对较低(P=0.040)。术中才作出诊断的患者,术后并发症发生率较术前已明确诊断者显著升高[48.4%(15/31)vs.25.7%(85/331),P=0.013)。手术期间接受药物治疗并不会影响并发症发生率。结论:约四分之一的克罗恩病患者行回结肠切除术后会出现近期并发症,其中穿透型病变和急诊手术患者术后并发症风险增高。
Background:This study is aimed at describing the prevalence of and risk factors associated with early post-operative complications after Crohn’s disease-related intestinal resection.Methods:This was a retrospective analysis of data from the PRACTICROHN cohort.Adult Crohn’s disease patients who underwent ileocolonic resection with ileocolonic anastomosis between January 2007 and December 2010 were included.The complications evaluated included death,ileus,anastomotic leak,abscess,wound infection,catheter-related infection,digestive bleeding and other extra-abdominal infections that occurred in the 30 days after surgery.Results:A total of 364 patients(median age at surgery 38 years and 50%men)were included.Indication for surgery was:stricturing disease(46.4%),penetrating disease(31.3%),penetrating and stricturing disease(14.0%)or resistance to medical treatment(5.8%).Early complications were recorded in 100(27.5%)patients,with wound infection,intra-abdominal abscess and anastomotic leakage being the most frequent complications.Median hospitalization duration was 16 days for patients with complications vs.9 days without complications(P<0.001).Complications were more common among patients with penetrating disease(36/114,31.6%)and those refractory to treatment(9/21,42.9%)compared with stricturing disease(45/169,26.6%)or stricturingtpenetrating disease(6/51,11.8%)(P=0.040).The rate of complications was higher among patients with diagnosis made at the time of surgery(15/31,48.4%)compared with the rest(85/331,25.7%)(P=0.013).Medication received at the time of surgery did not affect the rate of complications.Conclusions:Almost a quarter of patients developed early complications after intestinal resection.Penetrating disease and urgent surgery were associated with an increased risk of complications.
基金
supported by Merck Sharp and Dohme,Spain.
