Department of Surgery, Tel-Aviv Medical Center and Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
Dis Colon Rectum. 2012 Nov;55(11):1125-30. doi: 10.1097/DCR.0b013e318267c74c.
Rates of postoperative complications are particularly high among patients with Crohn's disease.
The aim of this study was to assess whether positive inflammatory histological margins, among other factors, pose a risk for intra-abdominal septic complications in patients with Crohn's disease undergoing ileocolic resection.
A retrospective study of patient records, during 2000-2010, was conducted.
This investigation was performed at a single medical center.
Included were 166 individuals with Crohn's disease (85 males, mean age 35.6).
Ileocolic resection with primary anastomosis was performed.
The primary outcomes measured were postoperative intra-abdominal septic complications.
Twenty-five patients (15%) developed intra-abdominal septic complications, including anastomotic leak, intra-abdominal abscesses and collections, and enterocutaneous fistulas. There were no postoperative deaths. Univariate analysis revealed that a long course of disease before surgery, an emergency surgery, steroid treatment of more than 3 months before surgery, additional sigmoidectomy, and positive surgical margins detected on histopathological examination were associated with intra-abdominal septic complications. In a multivariate analysis, only disease duration longer than 10 years (OR 4.575 (CI 1.592-13.142), p = 0.005), additional sigmoidectomy (OR 5.768 (CI 1.088-30.568), p = 0.04), and positive histological resection margins (OR 2.996 (CI 1.085-8.277), p = 0.03) were found to be independent risk factors.
This study was limited by the incomplete data regarding preoperative albumin levels.
Positive histological margins, disease duration of more than 10 years, and added sigmoidectomy are independent risk factors that are associated with postoperative intra-abdominal septic complications in patients undergoing ileocolic resection for Crohn's disease. These risk factors should be considered when the need for a diverting stoma is questionable. A frozen section of the margins may assist in the decision as to a temporary ileostomy construction.
克罗恩病患者术后并发症发生率特别高。
本研究旨在评估克罗恩病患者行回肠结肠切除术时，炎症性组织学切缘阳性等因素是否会增加腹腔内感染性并发症的风险。
回顾性分析 2000 年至 2010 年期间的患者病历。
单家医疗中心。
纳入 166 例克罗恩病患者（85 例男性，平均年龄 35.6 岁）。
行回肠结肠切除术+一期吻合术。
术后腹腔内感染性并发症。
25 例（15%）患者发生腹腔内感染性并发症，包括吻合口漏、腹腔脓肿和积液、肠皮肤瘘。无术后死亡病例。单因素分析显示，术前疾病病程长、急诊手术、术前皮质类固醇治疗超过 3 个月、附加乙状结肠切除术和组织病理学检查阳性切缘与腹腔内感染性并发症相关。多因素分析显示，仅疾病病程超过 10 年（OR 4.575（95%CI 1.592-13.142），p = 0.005）、附加乙状结肠切除术（OR 5.768（95%CI 1.088-30.568），p = 0.04）和阳性组织学切除切缘（OR 2.996（95%CI 1.085-8.277），p = 0.03）是术后发生腹腔内感染性并发症的独立危险因素。
本研究受术前白蛋白水平数据不完整的限制。
组织学切缘阳性、病程超过 10 年和附加乙状结肠切除术是克罗恩病患者行回肠结肠切除术时与术后腹腔内感染性并发症相关的独立危险因素。在是否需要造口术存在疑问时，应考虑这些危险因素。切缘的冰冻切片可能有助于决定是否行临时回肠造口术。
