St Vincent's Hospital and University of Melbourne, Melbourne, Vic., Australia.
Colorectal Dis. 2013 Feb;15(2):187-97. doi: 10.1111/j.1463-1318.2012.03168.x.
Eighty per cent of patients with Crohn's disease require surgery, of whom 70% will require a further operation. Recurrence occurs at the anastomosis. Although often recommended, the impact of postoperative colonoscopy and treatment adjustment is unknown.
Patients with a bowel resection over a 10-year period were reviewed and comparison made between those who did and did not have a postoperative colonoscopy within 1 year of surgery, and those who did or did not have a step-up in drug therapy.
Of 222 patients operated on, 136 (65 men, mean age 33 years, mean disease duration 8 years, median follow-up 4 years) were studied. Of 70 patients with and 66 without postoperative colonoscopy, clinical recurrence occurred in 49% and 48% (NS) and further surgery in 9% and 5% (NS). Eighty-nine per cent of colonoscoped patients had a decision based on the colonoscopic findings: of these, 24% had a step-up of drug therapy [antibiotics (n =10), aminosalicylates (n=2), thiopurine (n=5), methotrexate (n=1)] and 76% had no step-up in drug therapy. In colonoscoped patients clinical recurrence occurred in 9 (60%) of 15 patients with, and 23 (49%) of 47 without step-up and surgical recurrence in 2 (13%) of 15 and 4 (9%) of 47 (NS).
Clinical recurrence occurs in a majority of patients soon after surgery. In this cohort, there was no clinical benefit from colonoscopy or increased drug therapy within 1 year after operation. However, the response to the endoscopic findings was not standardized and immunosuppressive therapy was uncommon. Standardizing timing of colonoscopy and drug therapy, including more intense therapy, may improve outcome, although this remains to be proven.
80%的克罗恩病患者需要手术，其中 70%将需要再次手术。复发发生在吻合口。虽然经常推荐，但术后结肠镜检查和治疗调整的影响尚不清楚。
回顾了 10 年内进行肠切除术的患者，并比较了手术 1 年内是否进行术后结肠镜检查以及是否进行药物治疗升级的患者。
在 222 例手术患者中，对 136 例（男 65 例，平均年龄 33 岁，平均病程 8 年，中位随访 4 年）进行了研究。在 70 例接受和 66 例未接受术后结肠镜检查的患者中，临床复发分别为 49%和 48%（NS），进一步手术分别为 9%和 5%（NS）。89%接受结肠镜检查的患者根据结肠镜检查结果做出决定：其中，24%的患者药物治疗升级[抗生素（n=10）、氨基水杨酸盐（n=2）、硫嘌呤（n=5）、甲氨蝶呤（n=1）]，76%的患者药物治疗未升级。在接受结肠镜检查的患者中，有临床复发的患者分别为 15 例中有 9 例（60%），47 例中无临床复发的患者有 23 例（49%），手术复发的患者分别为 15 例中有 2 例（13%），47 例中无手术复发的患者有 4 例（9%）（NS）。
手术后不久，大多数患者都会出现临床复发。在这组患者中，手术后 1 年内进行结肠镜检查或增加药物治疗并没有带来临床获益。然而，内镜检查结果的反应并未标准化，免疫抑制治疗也不常见。标准化结肠镜检查和药物治疗的时间，包括更强化的治疗，可能会改善结果，但这仍有待证明。
