Froehlich Florian, Juillerat Pascal, Pittet Valérie, Felley Christian, Mottet Christian, Vader John-Paul, Michetti Pierre, Gonvers Jean-Jacques
Division of Gastroenterology and Hepatology, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Lausanne, Switzerland.
Digestion. 2007;76(2):130-5. doi: 10.1159/000111027. Epub 2008 Feb 7.
At 1 year after a first resection, up to 80% of patients show an endoscopic recurrence, 10-20% have clinical relapse, and 5% have surgical recurrence. Smoking is one of the most important risk factors for postoperative recurrence. Preoperative disease activity and the severity of endoscopic lesions in the neoterminal ileum within the first postoperative year are predictors of symptomatic recurrence. Mesalazine is generally the first-line treatment used in the postoperative setting but still provokes considerable controversy as to its efficacy, in spite of the results of a meta-analysis. Immunosuppressive treatment (azathioprine, 6-mercaptopurine) is based on scant evidence but is currently used as a second-line treatment in postsurgical patients at high risk for recurrence, with symptoms or with early endoscopic lesions in the neoterminal ileum. Nitroimidazole antibiotics (metronidazole, ornidazole) are also effective in the control of active Crohn's disease in the postoperative setting. Given their known toxicity, they may be used as a third-line treatment as initial short-term prevention therapy rather than in the long term. Conventional corticosteroids, budesonide or probiotics have no proven role in postoperative prophylaxis. Infliximab has not as yet been studied for use in the prevention of relapse after surgery.
首次切除术后1年，高达80%的患者出现内镜复发，10 - 20%出现临床复发，5%出现手术复发。吸烟是术后复发最重要的危险因素之一。术后第1年内新末端回肠的术前疾病活动度和内镜病变严重程度是症状性复发的预测因素。美沙拉嗪通常是术后使用的一线治疗药物，但尽管有一项荟萃分析的结果，其疗效仍引发了相当大的争议。免疫抑制治疗（硫唑嘌呤、6 - 巯基嘌呤）依据的证据不足，但目前在有复发高风险、有症状或新末端回肠有早期内镜病变的术后患者中用作二线治疗。硝基咪唑类抗生素（甲硝唑、奥硝唑）在术后控制克罗恩病活动方面也有效。鉴于其已知的毒性，它们可作为三线治疗用于初始短期预防治疗，而非长期使用。传统皮质类固醇、布地奈德或益生菌在术后预防中未被证实有作用。英夫利昔单抗尚未被研究用于预防术后复发。
