Kotanagi H, Kramer K, Fazio V W, Petras R E
Departments of Colon and Rectal Surgery, Cleveland Clinic Foundation, Ohio 44195.
Dis Colon Rectum. 1991 Oct;34(10):909-16. doi: 10.1007/BF02049707.
The relationship between histologic changes at resection margins and anastomotic recurrence was evaluated in patients with Crohn's disease. Pathology and medical records from 1960 to 1977 identified 100 patients who met the following criteria: 1) no prior surgery for Crohn's disease, 2) small bowel or small bowel and colonic resection with anastomosis done for Crohn's disease at the Cleveland Clinic, and 3) resection margins available for microscopic analysis. The following histologic features of the margins were evaluated: edema, inflammation, lymphoid aggregates, pyloric metaplasia, fibrosis, cryptitis and crypt abscesses, ulcers, granulomas, villous shortening, mucin depletion, neuronal hyperplasia, and transmural inflammation. Additionally, margins were categorized as histologically normal, showing nonspecific changes, showing changes suggestive of Crohn's disease, and showing changes diagnostic for Crohn's disease. Anastomotic recurrence occurred in 50 patients after an average follow-up period of 11.5 years. Cumulative recurrence-free rates for the four margin categories were not significantly different. Anastomotic recurrence was not associated with any clinical or histologic feature or combination of features.
在克罗恩病患者中，评估了切除边缘的组织学变化与吻合口复发之间的关系。通过查阅1960年至1977年的病理学和医疗记录，确定了100例符合以下标准的患者：1）既往无克罗恩病手术史；2）在克利夫兰诊所因克罗恩病行小肠或小肠及结肠切除并吻合术；3）有可供显微镜分析的切除边缘。对边缘的以下组织学特征进行了评估：水肿、炎症、淋巴样聚集、幽门化生、纤维化、隐窝炎和隐窝脓肿、溃疡、肉芽肿、绒毛缩短、黏液缺失、神经元增生和透壁性炎症。此外，边缘被分类为组织学正常、显示非特异性变化、显示提示克罗恩病的变化以及显示诊断为克罗恩病的变化。50例患者在平均随访11.5年后发生了吻合口复发。四类边缘的累积无复发生存率无显著差异。吻合口复发与任何临床或组织学特征或特征组合均无关联。
