Shen Bo, Remzi Feza H, Brzezinski Aaron, Lopez Rocio, Bennett Ana E, Lavery Ian C, Queener Elaine, Fazio Victor W
Pouchitis Clinic, Digestive Disease Institute, Cleveland Clinic, Cleveland, Ohio 44195, USA.
Inflamm Bowel Dis. 2008 Jul;14(7):942-8. doi: 10.1002/ibd.20409.
Crohn's disease (CD) of the pouch is one of the leading causes of pouch failure in patients with restorative proctocolectomy. Risk factors for pouch failure in these patients are yet to be identified. The aim of the study was to assess risk factors associated with pouch failure in patients with CD of the pouch.
All patients with a confirmed diagnosis of CD of the pouch in the Pouchitis Clinic between 2002 and 2007 were evaluated. Patients with familial adenomatous polyposis, normal pouches, pouchitis, cuffitis, surgical complications, and other diseased pouch conditions were excluded. Pouch failure was defined as the requirement for a permanent diversion or pouch resection. Demographic and clinical factors were studied with univariable and multivariable analyses.
A total of 137 patients with CD of the pouch were included. Twenty-two patients (16%) developed pouch failure a median of 6 years after ileostomy takedown. Four of 50 patients (8.0%) with inflammatory CD, 4 of 30 (13.3%) with fibrostenotic CD, and 14 of 57 (24.6%) with fistulizing CD had pouch failure. A Kaplan-Meier plot for time to pouch failure by CD phenotype showed a trend toward association (P = 0.054) in patients with fistulizing CD. Adjusting for age, smoking status, and the use of immunomodulators or biologics, fistulizing CD was not found to be significantly associated with a higher hazard for pouch failure. Younger age, being an ex-smoker, and the use of immunomodulators or biologics were found to increase the hazard of pouch failure.
Younger age, being an ex-smoker, and the requirement for immunomodulators or biologics were associated with pouch failure. The identification of these risk factors may help delineate the natural history of CD of the pouch and shed light on proper clinical management and prognosis.
储袋克罗恩病（CD）是行结直肠切除储袋肛管吻合术患者储袋功能衰竭的主要原因之一。这些患者储袋功能衰竭的危险因素尚未明确。本研究旨在评估储袋型CD患者储袋功能衰竭的相关危险因素。
对2002年至2007年间储袋炎门诊确诊为储袋型CD的所有患者进行评估。排除患有家族性腺瘤性息肉病、储袋正常、储袋炎、袖口炎、手术并发症及其他储袋病变情况的患者。储袋功能衰竭定义为需要永久性造口转流或切除储袋。采用单因素和多因素分析研究人口统计学和临床因素。
共纳入137例储袋型CD患者。22例患者（16%）在回肠造口关闭术后中位6年出现储袋功能衰竭。50例炎症型CD患者中有4例（8.0%）、30例纤维狭窄型CD患者中有4例（13.3%）、57例瘘管型CD患者中有14例（24.6%）出现储袋功能衰竭。按CD表型绘制的储袋功能衰竭时间的Kaplan-Meier曲线显示，瘘管型CD患者存在关联趋势（P = 0.054）。校正年龄、吸烟状态以及免疫调节剂或生物制剂的使用情况后，未发现瘘管型CD与储袋功能衰竭风险升高存在显著关联。发现年龄较小、既往吸烟以及使用免疫调节剂或生物制剂会增加储袋功能衰竭风险。
年龄较小、既往吸烟以及需要使用免疫调节剂或生物制剂与储袋功能衰竭相关。识别这些危险因素可能有助于描绘储袋型CD的自然病程，并为恰当的临床管理和预后提供线索。
