Greenstein A J, Sachar D B, Pasternack B S, Janowitz H D
N Engl J Med. 1975 Oct 2;293(14):685-90. doi: 10.1056/NEJM197510022931403.
To determine the risks of reoperation and clinical recurrence in Crohn's disease involving the colon, we analyzed by both crude and actuarial (life-table) methods follow-up data from 160 patients hospitalized with Crohn's colitis or ileocolitis from 1964 through 1973. A total of 100 patients (63 per cent) underwent major operation; of these, 58 required reoperation. By the 15th year after initial operation, there was a cumulative reoperation rate of 89 and an overall clinical recurrence rate of 94 per cent. Crude data implied that the reoperation rate diminished with each succeeding operative procedure, from 58 per cent after the first operation to 47 per cent after the fourth. By contrast, actuarial analysis revealed that at the three-year follow-up point, the cumulative chance of reoperation increased from 37 per cent after the first surgical procedure to 60 per cent after the fourth. The inexorable tendency of Crohn's ileocolitis to require repeated operations is demonstrable by actuarial methods.
为了确定累及结肠的克罗恩病再次手术及临床复发的风险，我们采用原始数据和精算（寿命表）方法，分析了1964年至1973年期间因克罗恩结肠炎或回结肠炎症住院的160例患者的随访数据。共有100例患者（63%）接受了大手术；其中58例需要再次手术。初次手术后到第15年，再次手术的累积发生率为89%，临床总体复发率为94%。原始数据表明，随着后续每次手术，再次手术率逐渐降低，从第一次手术后的58%降至第四次手术后的47%。相比之下，精算分析显示，在三年随访期时，再次手术的累积概率从第一次手术后的37%增至第四次手术后的60%。精算方法证实了克罗恩回结肠炎不可避免地需要多次手术的趋势。
