Department of Colorectal Surgery, Digestive Disease Institute, Cleveland Clinic, 9500 Euclid Avenue A-30, Cleveland, OH 44195, USA.
Langenbecks Arch Surg. 2013 Jan;398(1):39-45. doi: 10.1007/s00423-011-0865-9. Epub 2011 Oct 22.
Whether smoking affects disease distribution, phenotype, and perioperative outcomes for Crohn's disease (CD) patients undergoing surgery is not well characterized. The aim of this study is to evaluate the impact of smoking on disease phenotype and postoperative outcomes for CD patients undergoing surgery
Prospectively collected data of CD patients undergoing colorectal resection were evaluated. CD patients who were current smokers (CS) were compared to nonsmokers (NS) and ex-smokers (ES) for disease phenotype, anatomic site involved, procedures performed, postoperative outcomes, and quality of life using the Cleveland Global Quality of Life instrument (CGQL).
Of 691 patients with a diagnosis of CD requiring surgery 314 were classified as CS, 330 as NS, and 47 as ES. CS and ES in comparison to NS were significantly older at diagnosis of Crohn's disease (mean, 29.3 vs. 29.2 vs. 26.3 years) (P = 0.001) and older at the time of primary surgery (mean, 42.9 vs. 48.4 vs. 39 years) (P = 0.001) with a greater frequency of diabetes. In all groups requiring surgery, there was a significant change in disease phenotype from the time of diagnosis to surgical intervention. The predominant phenotype at diagnosis was inflammatory which changed to stricturing and penetrating as the dominant phenotypes at time of surgery. All groups had a significant improvement in CGQL scores post-surgery with the greatest benefit observed in NS. Postoperative complications and 30-day readmission rates were similar between all groups.
The findings of this study show that in patients with CD, disease phenotype changes over time. This occurs independent of smoking. Smoking does not appear to predispose to complications for CD patients undergoing surgery. CS and ES have a persistently reduced quality of life in comparison to NS post-surgery.
吸烟是否会影响接受手术的克罗恩病（CD）患者的疾病分布、表型和围手术期结局尚不清楚。本研究旨在评估吸烟对接受结直肠切除术的 CD 患者的疾病表型和术后结局的影响。
评估了接受结直肠切除术的 CD 患者的前瞻性收集数据。将当前吸烟者（CS）与非吸烟者（NS）和前吸烟者（ES）进行比较，比较项目包括疾病表型、受累解剖部位、手术方式、术后结局和克利夫兰全球生活质量量表（CGQL）的生活质量。
在 691 例需要手术的 CD 患者中，314 例被归类为 CS，330 例为 NS，47 例为 ES。与 NS 相比，CS 和 ES 诊断 CD 的年龄更大（平均年龄 29.3 岁比 29.2 岁比 26.3 岁）（P = 0.001），初次手术时年龄更大（平均年龄 42.9 岁比 48.4 岁比 39 岁）（P = 0.001），且糖尿病发病率更高。在所有需要手术的组中，从诊断到手术干预，疾病表型都发生了显著变化。诊断时的主要表型是炎症性的，在手术时变为狭窄和穿透性。所有组的 CGQL 评分在手术后均有显著改善，NS 组的获益最大。所有组的术后并发症和 30 天再入院率相似。
本研究结果表明，在 CD 患者中，疾病表型随时间而变化。这与吸烟无关。吸烟似乎不会使接受手术的 CD 患者更容易发生并发症。CS 和 ES 术后的生活质量与 NS 相比持续降低。
