Welsch Thilo, Hinz Ulf, Löffler Thorsten, Muth Gregor, Herfarth Christian, Schmidt Jan, Kienle Peter
Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany.
Int J Colorectal Dis. 2007 Sep;22(9):1043-9. doi: 10.1007/s00384-007-0309-8. Epub 2007 Mar 28.
There is evidence suggesting that stenosing and fistulising Crohn's diseases reflect specific entities. The aim of this study was to compare these two clinical presentations with regards to anastomotic recurrence after ileocaecal resection and identify other relevant risk factors.
One hundred consecutive patients undergoing isolated ileocaecal resection for Crohn's disease were included in this follow-up study. A recurrence was either defined endoscopically, on the basis of radiological examinations or on the basis of a re-operation. In addition, patients had to complain of clinical symptoms. Recurrence-free intervals were calculated by the Kaplan-Meier method. Univariate and multivariate analysis including previously identified risk factors for recurrence were performed.
Of the 100 patients extracted from the database, 8 patients were lost to follow-up or refused participation. There was no mortality in this patient group, the morbidity was 16.3%. The recurrence rates after 5 and 9 years were 28.7% and 56.4%, respectively. Univariate analysis revealed re-laparotomy within the same hospital stay and length of resected specimen as significant factors for anastomotic recurrence. Both these factors were confirmed on multivariate analysis. But when analysing the observation period in detail, specimen length was not any more a significant factor in the later time period (1996-2000) compared to the earlier time period (1991-1995). The clinical presentation (fistulising vs stenosing) showed no significant influence on the recurrence rates.
Patients with stenosing and fistulising Crohn's disease of the ileocaecal region have no difference in recurrence rates after resection. Re-laparotomy in the same hospital stay was an independent predictor of recurrence.
有证据表明，狭窄型和瘘管型克罗恩病反映了特定的实体。本研究的目的是比较这两种临床表现的回盲部切除术后吻合口复发情况，并确定其他相关危险因素。
本随访研究纳入了100例因克罗恩病接受单纯回盲部切除术的连续患者。复发通过内镜检查、放射学检查或再次手术来定义。此外，患者必须有临床症状。采用Kaplan-Meier法计算无复发生存期。进行单因素和多因素分析，包括先前确定的复发危险因素。
从数据库中提取的100例患者中，8例失访或拒绝参与。该患者组无死亡病例，发病率为16.3%。5年和9年的复发率分别为28.7%和56.4%。单因素分析显示，同一住院期间再次开腹手术和切除标本长度是吻合口复发的重要因素。这两个因素在多因素分析中均得到证实。但在详细分析观察期时，与早期（1991 - 1995年）相比，标本长度在后期（1996 - 2000年）不再是一个显著因素。临床表现（瘘管型与狭窄型）对复发率无显著影响。
回盲部狭窄型和瘘管型克罗恩病患者切除术后的复发率无差异。同一住院期间再次开腹手术是复发的独立预测因素。
