Scarpa Marco, Ruffolo Cesare, Bertin Eugenia, Polese Lino, Filosa Teresa, Prando Daniela, Pagano Duilio, Norberto Lorenzo, Frego Mauro, D'Amico Davide F, Angriman Imerio
Clinica Chirurgica I, Dipartimento di Scienze Chirurgiche e Gastroenterologiche, Policlinico Universitario, Università di Padova, via Giustiniani 2, 35128 Padova, Italy.
Int J Colorectal Dis. 2007 Sep;22(9):1061-9. doi: 10.1007/s00384-007-0329-4. Epub 2007 May 30.
BACKGROUND/AIMS: Anastomotic recurrence after bowel resection is a major problem in Crohn's disease (CD) surgery. The aims of this retrospective study are to assess the role of anastomotic configuration, the type of suture and the type of surgical approach (laparoscopy-assisted vs laparotomy) in CD recurrence. Secondary end points were to identify any possible predictor that would help the selection of patients for medical prophylaxis.
In this retrospective study, we enrolled 141 consecutive patients who had undergone ileocolonic resection for CD. Univariate actuarial analysis was performed according to demographic, clinical and surgical predictors. Variables that resulted to be significant at the univariate analysis were included in two multivariate Cox proportional hazards models that analyzed symptomatic and surgical recurrence, respectively.
In the long-term, handsewn side-to-side anastomosis reported a significantly lower surgical recurrence rate than stapled end-to-side (p < 0.05). At multivariate analysis, anastomosis type, surgical and intestinal complications (p < 0.01) and age at CD onset (p < 0.05) resulted to be significant predictors for re-operation for CD recurrence. Multivariate analysis showed that surgical complication was also a significant predictor of symptomatic recurrence.
Side-to-side anastomosis configuration seems to delay re-operation and can be assumed as the standard configuration in ileocolonic anastomosis in CD. Post-operative complications and young age at disease onset might be a signal of aggressive CD that may warrant prophylactic pharmacological therapy.
背景/目的：肠切除术后吻合口复发是克罗恩病（CD）手术中的一个主要问题。本回顾性研究的目的是评估吻合口构型、缝合类型及手术方式（腹腔镜辅助手术与开腹手术）在CD复发中的作用。次要终点是确定有助于选择接受药物预防治疗患者的任何可能预测因素。
在本回顾性研究中，我们纳入了141例因CD接受回结肠切除术的连续患者。根据人口统计学、临床和手术预测因素进行单因素精算分析。在单因素分析中具有显著意义的变量被纳入两个多因素Cox比例风险模型，分别分析症状性复发和手术复发。
长期来看，手工缝合的侧侧吻合术的手术复发率显著低于吻合器端端吻合术（p<0.05）。多因素分析显示，吻合口类型、手术及肠道并发症（p<0.01）和CD发病年龄（p<0.05）是CD复发再次手术的显著预测因素。多因素分析表明，手术并发症也是症状性复发的显著预测因素。
侧侧吻合构型似乎可延迟再次手术，可被视为CD回结肠吻合术的标准构型。术后并发症及发病时年龄较小可能是侵袭性CD的信号，可能需要预防性药物治疗。
