Healthcare Evaluation Unit, Institute of Social and Preventive Medicine, Lausanne, Switzerland.
Digestion. 2013;87(3):212-21. doi: 10.1159/000350954. Epub 2013 May 23.
About 80% of patients with Crohn's disease (CD) require bowel resection and up to 65% will undergo a second resection within 10 years. This study reports clinical risk factors for resection surgery (RS) and repeat RS.
Retrospective cohort study, using data from patients included in the Swiss Inflammatory Bowel Disease Cohort. Cox regression analyses were performed to estimate rates of initial and repeated RS.
Out of 1,138 CD cohort patients, 417 (36.6%) had already undergone RS at the time of inclusion. Kaplan-Meier curves showed that the probability of being free of RS was 65% after 10 years, 42% after 20 years, and 23% after 40 years. Perianal involvement (PA) did not modify this probability to a significant extent. The main adjusted risk factors for RS were smoking at diagnosis (hazard ratio (HR) = 1.33; p = 0.006), stricturing with vs. without PA (HR = 4.91 vs. 4.11; p < 0.001) or penetrating disease with vs. without PA (HR = 3.53 vs. 4.58; p < 0.001). The risk factor for repeat RS was penetrating disease with vs. without PA (HR = 3.17 vs. 2.24; p < 0.05).
The risk of RS was confirmed to be very high for CD in our cohort. Smoking status at diagnosis, but mostly penetrating and stricturing diseases increase the risk of RS.
约 80%的克罗恩病（CD）患者需要进行肠道切除术，多达 65%的患者在 10 年内将进行第二次切除术。本研究报告了与肠道切除术（RS）和重复 RS 相关的临床危险因素。
回顾性队列研究，使用纳入瑞士炎症性肠病队列研究中的患者数据。采用 Cox 回归分析来评估首次和重复 RS 的发生率。
在 1138 名 CD 队列患者中，417 名（36.6%）在纳入时已经接受过 RS。Kaplan-Meier 曲线显示，10 年后 RS 无进展的概率为 65%，20 年后为 42%，40 年后为 23%。肛周病变（PA）并未显著改变这一概率。RS 的主要调整后危险因素是诊断时吸烟（风险比（HR）=1.33；p=0.006）、伴或不伴 PA 的狭窄性疾病（HR=4.91 比 4.11；p<0.001）或伴或不伴 PA 的穿透性疾病（HR=3.53 比 4.58；p<0.001）。重复 RS 的危险因素是伴或不伴 PA 的穿透性疾病（HR=3.17 比 2.24；p<0.05）。
在我们的队列中，CD 患者的 RS 风险被证实非常高。诊断时的吸烟状况，但主要是穿透性和狭窄性疾病，增加了 RS 的风险。
