Sokol H, Polin V, Lavergne-Slove A, Panis Y, Treton X, Dray X, Bouhnik Y, Valleur P, Marteau P
AP-HP, Saint-Antoine Hospital, Gastroenterology and Nutrition Department, Paris, France.
Gut. 2009 Sep;58(9):1218-25. doi: 10.1136/gut.2009.177782. Epub 2009 Jul 21.
A previous study suggested that the presence of myenteric plexitis in the proximal resection margins could be predictive of early endoscopic recurrence after ileocolonic or ileal resection for Crohn's disease (CD). The aim of the present study was to assess the predictive value of plexitis for early clinical CD recurrence.
All consecutive patients with ileocolonic or ileal resection for active CD in Lariboisière Hospital (Paris) between 1995 and 2006 were included. Clinical, surgical, histological and follow-up data were extracted from medical charts. Early clinical recurrence was defined as the reappearance of CD clinical manifestations requiring a specific treatment within 2 years postsurgery. The proximal resection margin was analysed using haematein eosin saffron (HES) staining and immunochemistry targeting mastocytes (anti-CD117 antibody) and lymphocytes (anti-CD3 antibody). Eosinophils were detected by HES staining. Ten cases of ileocolonic resections for caecal carcinoma served as controls.
Data were available from 171 postoperative follow-up periods in 164 patients with CD. Early clinical recurrence of CD occurred in 28.1%. In multivariate analysis, factors associated with postoperative recurrence were active smoking (hazard ratio (HR) = 1.94; 95% CI 1.06 to 3.60; p = 0.033), submucosal plexitis with >or=3 mastocytes (HR = 1.87; 95% CI 1.00 to 3.46; p = 0.048) and a disease-free resection margin <5 cm (HR = 0.52; 95% CI 0.27 to 1.02; p = 0.059).
Submucosal plexitis is associated with early clinical recurrence and could be taken into account in studies searching for new treatment strategies in the immediate postoperative period.
先前的一项研究表明，在克罗恩病（CD）行回结肠或回肠切除术后，近端切缘存在肌间神经丛炎可能是早期内镜复发的预测指标。本研究旨在评估神经丛炎对CD早期临床复发的预测价值。
纳入1995年至2006年间在巴黎拉里博伊斯医院因活动性CD行回结肠或回肠切除术的所有连续患者。从病历中提取临床、手术、组织学和随访数据。早期临床复发定义为术后2年内再次出现需要特定治疗的CD临床表现。使用苏木精伊红藏红花（HES）染色以及针对肥大细胞（抗CD117抗体）和淋巴细胞（抗CD3抗体）的免疫化学方法分析近端切缘。通过HES染色检测嗜酸性粒细胞。选取10例因盲肠癌行回结肠切除术的病例作为对照。
164例CD患者中有171个术后随访期的数据可用。CD早期临床复发率为28.1%。多因素分析显示，与术后复发相关的因素有主动吸烟（风险比（HR）=1.94；95%置信区间1.06至3.60；p=0.033）、黏膜下神经丛炎伴≥3个肥大细胞（HR=1.87；95%置信区间1.00至3.46；p=0.048）以及无病切缘<5 cm（HR=0.52；95%置信区间0.27至1.02；p=0.059）。
黏膜下神经丛炎与早期临床复发相关，在探索术后即刻新治疗策略的研究中应予以考虑。
