克罗恩病行改良对系膜缘功能性端端吻合术的疗效研究

Postoperative efficacy study of modified anti-mesenteric functional end-to-end anastomosis on Crohn's disease

目的探讨克罗恩病(CD)患者行改良对系膜缘功能性端端吻合即Kono-S术的疗效。方法采用回顾性队列研究方法。收集2020年1月至2023年4月在南京大学医学院附属金陵医院接受改良Kono-S术的CD患者的临床资料。主要终点为术后内镜复发率,次要终点为术后30 d并发症发生率、术后临床复发率以及内镜复发的影响因素。内镜复发定义为Rutgeerts评分评价吻合口复发情况,达到i2b及以上。临床复发定义为在吻合口内镜复发的基础上,克罗恩病活动指数(CDAI)>150分。根据内镜复发情况将患者分为复发组和无复发组,采用单因素分析和多因素Logistic回归分析内镜复发的影响因素。结果共纳入75例CD患者,男性46例,女性29例;年龄(38.5±14.1)岁;CDAI评分为(71.8±22.6)分;接受小肠部分切除术60例,回盲部切除术6例,右半结肠切除术6例,结肠大部切除术3例;手术时间为(116±27)min;改良Kono-S术吻合时间为(24±4)min。术后30 d,Clavien-Dindo分级Ⅱ级及以上并发症发生率为12%(9/75),无腹腔感染性并发症及死亡。随访时间15(6,23)个月,39例患者进行内镜检查,术后吻合口内镜复发率为20.5%(8/39),临床复发率为2.6%(1/39)。男性为改良Kono-S术后吻合口内镜复发的独立危险因素(OR=18.7,95%CI:1.7~200.8,P=0.02)。结论改良Kono-S术治疗CD安全便捷,术后吻合口内镜复发风险较低,其中男性更易复发。

Objective To investigate the efficacy of modified anti-mesenteric functional end-to-end anastomosis(Kono-S)on Crohn's disease(CD).Methods A retrospective cohort study was conducted.Clinical data of CD patients who underwent modified Kono-S surgery at Jinling Hospital of Medical School of Nanjing University from January 2020 to April 2023 were collected.Primary endpoint was postoperative endoscopic recurrence rate.Secondary endpoints were postoperative complication rate within 30 days,postoperative clinical recurrence rate,and factors influencing endoscopic recurrence.Endoscopic recurrence was defined as Rutgeerts score of i2b or higher at the anastomotic stomas.Clinical recurrence was defined as Crohn's disease activity index(CDAI)>150 points based on the endoscopic recurrence.Patients were divided into recurrence and non-recurrence groups according to the endoscopic recurrence,and univariate analysis and multivariate Logistic regression analysis were used to identify factors of endoscopic recurrence.Results A total of 75 CD patients[46 men,29 women;mean age,(38.5±14.1)years;mean CDAI score,(71.8±22.6)points]were included.Sixty patients underwent partial small bowel resection,6 underwent ileocecal resection,6 underwent right hemicolectomy,and 3 underwent subtotal colectomy.The operation time was(116±27)minutes,and the time of the modified Kono-S anastomosis construction was(24±4)minutes.Incidence rate of Clavien-Dindo gradeⅡor higher complications was 12%(9/75)within 30 days postoperatively,with no intra-abdominal infectious complication and death.During the follow-up period of 15(6,23)months,39 patients underwent endoscopic examination,and the endoscopic recurrence rate was 20.5%(8/39)and clinical recurrence rate was 2.6%(1/39).Male was identified as the independent risk factor for endoscopic recurrence(OR=18.7,95%CI:1.7-200.8,P=0.02).Conclusion Modified Kono-S is a safe and convenient treatment for CD with a low risk of anastomotic endoscopic recurrence,however,male patients are more prone to the recurrence.