Ecker K W, Gierend M, Kreissler-Haag D, Feifel G
Department of General, Abdominal and Vascular Surgery, University of Saarland, 66421 Homburg/Saar, Germany.
Int J Colorectal Dis. 2001 Apr;16(2):76-80. doi: 10.1007/s003840000279.
After ileostomy construction for Crohn's disease reoperations due to ileal recurrences are thought to be unusually rare, whereas reconstructions of the ileostomy due to stoma complications are considered to be unusually frequent. It remains unclear why the natural course of a disease as well as outstanding results of a standardized surgical procedure should be perverted. Therefore reconstructions of the ileostomy in 92 patients colectomized during a 12.5-year period and followed up for 5.4 years were analyzed concerning preoperative indication and postoperative histology. In 28 patients (30.4%) a total of 42 reoperations were necessary. The clinical indication was prestomal recurrence in 5 reoperations (11.9%) and stoma complications in 37 (88.1%). In contrast, ileal recurrence was demonstrated histologically in 28 specimens (66.7%) and healthy ileum in the rest. There was a statistically significant association between fibrotic recurrence and stoma stenosis/retraction and a trend for association between penetrating recurrence and peristomal ulceration. The cumulative risk for a first reoperation due to clinical recurrence was calculated at 3.3% and 14.0% at 5 and 10 years postoperatively, whereas the corresponding figures for stoma complications were 25.7% and 40.0%. In contrast, the cumulative risk that a recurrence was found histologically on the occasion of the reoperation was 23.0% and 35.0%, while the probability that the ileum was healthy in the case of a stoma complication remained low. In conclusion, most reoperations after ileostomy-construction in Crohn's disease are associated histologically with recurrent inflammation. The accentuation of the inflammatory recrudescence at the stoma itself or the prestomal ileum is decisive for the clinical presentation as stoma complication or intestinal complication. These findings reinforce both well known characteristics of the inflammatory disease and of established surgery.
由于回肠复发而进行克罗恩病再次手术时，回肠造口术后的回肠复发被认为异常罕见，而因造口并发症进行回肠造口重建则被认为异常频繁。目前尚不清楚为何一种疾病的自然病程以及标准化手术程序的显著效果会被扭曲。因此，对在12.5年期间接受结肠切除术并随访5.4年的92例患者的回肠造口重建进行了分析，涉及术前指征和术后组织学情况。28例患者（30.4%）共进行了42次再次手术。临床指征方面，5次再次手术（11.9%）是造口前复发，37次（88.1%）是造口并发症。相比之下，28个标本（66.7%）组织学显示有回肠复发，其余为健康回肠。纤维化复发与造口狭窄/回缩之间存在统计学显著关联，穿透性复发与造口周围溃疡之间有关联趋势。术后5年和10年因临床复发进行首次再次手术的累积风险分别计算为3.3%和14.0%，而造口并发症的相应数字为25.7%和40.0%。相反，再次手术时组织学发现复发的累积风险为23.0%和35.0%，而造口并发症时回肠健康的概率仍然很低。总之，克罗恩病回肠造口术后的大多数再次手术在组织学上与复发性炎症相关。造口本身或造口前回肠处炎症复发的加重对于临床表现为造口并发症或肠道并发症起决定性作用。这些发现强化了炎症性疾病和既定手术的两个众所周知的特征。
