Aratari A, Papi C, Leandro G, Viscido A, Capurso L, Caprilli R
Gastroenterology Unit, Department of Clinical Sciences, University of Rome 'La Sapienza', Rome, Italy.
Aliment Pharmacol Ther. 2007 Nov 15;26(10):1303-12. doi: 10.1111/j.1365-2036.2007.03515.x. Epub 2007 Sep 10.
Surgical resection is almost inevitable in Crohn's disease. Surgery is usually performed for refractory or complicated disease: no studies appear to have been carried out, so far, to evaluate the potential benefits of performing surgery early in the course of the disease.
To compare the long-term course of Crohn's disease following ileo-caecal resection performed at the time of diagnosis (early surgery) or during the course of the disease (late surgery). Patients and methods Overall 207 patients with ileo-caecal Crohn's disease at their first resection were reviewed: 83 patients underwent surgery at the time of diagnosis (early surgery), while 124 underwent surgery 54.2 months (range 1-438) after diagnosis (late surgery). The mean follow-up after surgery was 147 months (range 12-534). The primary endpoint was clinical recurrence, defined as need for corticosteroids for symptomatic disease in the presence of endoscopic and/or radiologic recurrence. Secondary endpoints were need for immunosuppressants and surgical recurrence.
Kaplan-Meier survival method and Cox proportional hazards regression model.
Within 10 years after surgery, the cumulative probability of clinical recurrence was significantly lower in the early surgery group (Log Rank test P = 0.01). A trend was observed regarding the need for immunosuppressants (P = 0.05). No difference was observed regarding surgical recurrence. At multivariate analysis, early surgery was the only independent variable associated with a reduced risk of clinical recurrence (Hazard ratio, HR = 0.57; 95% CI 0.35 to 0.92, P = 0.02), but not with need for immunosuppressants and surgical recurrence (HR = 0.51; 95% CI 0.20 to 1.30, P = 0.15; HR = 0.66; 95% CI 0.33 to 1.35, P = 0.25, respectively).
Early surgery prolongs clinical remission compared to surgery performed during the course of the disease, but the natural history of disease is not modified.
克罗恩病几乎不可避免地需要进行手术切除。手术通常用于治疗难治性或复杂性疾病：到目前为止，似乎尚未开展研究来评估在疾病病程早期进行手术的潜在益处。
比较在诊断时（早期手术）或疾病病程中（晚期手术）进行回盲部切除术后克罗恩病的长期病程。患者与方法 对首次接受手术的207例回盲部克罗恩病患者进行了回顾性研究：83例患者在诊断时接受了手术（早期手术），而124例患者在诊断后54.2个月（范围1 - 438个月）接受了手术（晚期手术）。术后平均随访时间为147个月（范围12 - 534个月）。主要终点是临床复发，定义为在内镜和/或放射学复发的情况下，因症状性疾病需要使用皮质类固醇。次要终点是使用免疫抑制剂的需求和手术复发。
采用Kaplan - Meier生存法和Cox比例风险回归模型。
术后10年内，早期手术组临床复发的累积概率显著较低（对数秩检验P = 0.01）。在使用免疫抑制剂的需求方面观察到一种趋势（P = 0.05）。在手术复发方面未观察到差异。多因素分析时，早期手术是与临床复发风险降低相关的唯一独立变量（风险比，HR = 0.57；95%置信区间0.35至0.92，P = 0.02），但与使用免疫抑制剂的需求和手术复发无关（HR分别为0.51；95%置信区间0.20至1.30，P = 0.15；HR = 0.66；95%置信区间0.33至1.35，P = 0.25）。
与在疾病病程中进行的手术相比，早期手术可延长临床缓解期，但疾病的自然病程并未改变。
