Sampietro Gianluca M, Cristaldi Massimo, Maconi Giovanni, Parente Fabrizio, Sartani Alessandra, Ardizzone Sandro, Danelli Piergiorgio, Bianchi Porro Gabriele, Taschieri Angelo Maria
Department of Surgery, II Division of General Surgery, Università degli Studi di Milano, Ospedale Luigi Sacco, Milan, Italy.
J Am Coll Surg. 2004 Jul;199(1):8-20; discussion 20-2. doi: 10.1016/j.jamcollsurg.2004.01.039.
Bowel-sparing techniques have been proposed to avoid extended or repeated resections in patients with Crohn'rsquo;s disease (CD), but without precise indications, prospective evaluation, and with a technically limited repertoire.
A prospective longitudinal study of new nonconventional strictureplasties (NCSP) in order to evaluate the safety, type and site of recurrence, and longterm clinical and surgical efficacy.
Between January 1993 and December 2002, 102 among 305 consecutive patients underwent at least one NCSP for complicated CD. Patients were treated following precise indications and then included in a prospective database with scheduled followup. Factors claimed to influence postoperative and longterm outcomes and type and site of recurrence were analyzed. We performed 48 ileoileal side-to-side isoperistaltic strictureplasty (SP), 41 widening ileocolic SP, 32 ileocolic side-to-side isoperistaltic SP, associated with Heineke-Mikulicz SP (in 80 procedures) or with minimal bowel resections or both (in 47 procedures). Postoperative mortality was nil; complication rate was 5.7%. Ten years clinical and surgical recurrence rates were 43% and 27%, respectively. Recurrence rate on an NCSP site was 0.8%. No specific factor was identified as related to postoperative or longterm outcomes.
Perioperative and longterm results of NCSP are comparable to or even better than both conservative and resective surgery as reported in the literature, with a low recurrence rate on the NCSP site. Considering the unpredictability of the clinical course of CD and the lifetime need for surgical procedures, NCSP, together with minimal resection and classic SP repertoire, should be considered first-line treatment in complicated CD.
已提出保留肠段技术以避免对克罗恩病（CD）患者进行广泛或重复切除，但缺乏精确的适应证、前瞻性评估，且技术手段有限。
一项关于新型非传统狭窄成形术（NCSP）的前瞻性纵向研究，以评估其安全性、复发类型和部位以及长期临床和手术疗效。
1993年1月至2002年12月期间，305例连续性患者中有102例因复杂性CD至少接受了一次NCSP。患者按照精确的适应证进行治疗，然后纳入前瞻性数据库并进行定期随访。分析了据称会影响术后和长期结局以及复发类型和部位的因素。我们进行了48例回肠-回肠侧侧同向蠕动狭窄成形术（SP）、41例扩大回结肠SP、32例回结肠侧侧同向蠕动SP，联合海涅克-米库利奇SP（80例手术）或联合最小限度肠切除或两者联合（47例手术）。术后死亡率为零；并发症发生率为5.7%。10年临床和手术复发率分别为43%和27%。NCSP部位的复发率为0.8%。未发现与术后或长期结局相关的特定因素。
NCSP的围手术期和长期结果与文献报道的保守手术和切除手术相当，甚至更好，NCSP部位的复发率较低。考虑到CD临床病程的不可预测性以及患者一生对手术的需求，NCSP连同最小限度切除和经典SP技术应被视为复杂性CD的一线治疗方法。
