Yamamoto T, Allan R N, Keighley M R
University Department of Surgery, Queen Elizabeth Hospital, Edgbaston, Birmingham B15 2TH, UK.
World J Surg. 1999 Oct;23(10):1055-60; discussion 1060-1. doi: 10.1007/s002689900623.
After resection for ileocecal or ileocolonic Crohn's disease anastomotic recurrence is common, and many patients require further surgery. This study reviews our overall experience of surgery for ileocolonic anastomotic recurrence of Crohn's disease so we can propose a strategy for management. A series of 109 patients who underwent surgery for anastomotic recurrence after ileocecal or ileocolonic resection for Crohn's disease between 1984 and 1997 were reviewed. Ileocolonic recurrence was treated by strictureplasty in 39 patients and resection in 70 (with sutured end-to-end anastomosis, 48; stapled side-to-side anastomosis, 22). Stapled anastomosis has been frequently used between 1995 and 1997. Short recurrence was mainly treated by strictureplasty, and long or perforating disease was resected. Coexisting small bowel disease was more common in the patients having strictureplasty. Septic complications (leak/fistula/abscess) related to the ileocolonic procedure occurred in 1 of 39 patients (3%) after strictureplasty, in 6 of 48 (13%) after resection with sutured anastomosis, and in none of 22 after resection with stapled anastomosis. The median duration of follow-up was 90 months after strictureplasty, 105 months after resection with sutured anastomosis, and 22 months after resection with stapled anastomosis. Altogether 18 of 39 patients (46%) after strictureplasty, 22 of 48 (46%) after resection with sutured anastomosis, and none of 22 after resection with stapled anastomosis required further surgery for suture line recurrence. In conclusion, strictureplasty is useful for short ileocolonic recurrence in patients with multifocal small bowel disease or previous extensive resection. Stapled side-to-side anastomosis was associated with a low incidence of complications, and early recurrence was not observed, although the duration of follow-up was short.
在对回盲部或回结肠型克罗恩病进行切除术后，吻合口复发很常见，许多患者需要进一步手术。本研究回顾了我们对克罗恩病回结肠吻合口复发进行手术的总体经验，以便我们能够提出一种管理策略。回顾了1984年至1997年间因克罗恩病接受回盲部或回结肠切除术后吻合口复发而接受手术的109例患者。39例回结肠复发患者采用狭窄成形术治疗，70例采用切除术（端端缝合吻合术48例，侧侧吻合器吻合术22例）。1995年至1997年间频繁使用吻合器吻合术。短段复发主要采用狭窄成形术治疗，长段或穿孔性病变则行切除术。狭窄成形术患者并存小肠疾病更为常见。狭窄成形术后39例患者中有1例（3%）发生与回结肠手术相关的感染性并发症（渗漏/瘘管/脓肿），端端缝合吻合术切除术后48例中有6例（13%）发生，侧侧吻合器吻合术切除术后22例均未发生。狭窄成形术后随访时间中位数为90个月，端端缝合吻合术切除术后为105个月，侧侧吻合器吻合术切除术后为22个月。狭窄成形术后39例患者中有18例（46%）、端端缝合吻合术切除术后48例中有22例（46%）、侧侧吻合器吻合术切除术后22例均未因吻合口复发而需要进一步手术。总之，狭窄成形术对多灶性小肠疾病或既往广泛切除的患者的短段回结肠复发有用。侧侧吻合器吻合术并发症发生率低，尽管随访时间短，但未观察到早期复发。
