Division of Surgery, Department of Clinical and Experimental Medicine, Faculty of Health Sciences, Linköping University, and Department of Surgery, County Council of Östergötland, Linköping, Sweden; Department of Surgery, Unit of Colorectal Surgery, Oxford University Hospitals, Oxford, UK.
Br J Surg. 2014 Apr;101(5):539-45. doi: 10.1002/bjs.9439. Epub 2014 Feb 26.
The use of biological therapy (biologicals) is established in the treatment of Crohn's disease. This study aimed to determine whether preoperative treatment with biologicals is associated with an increased rate of complications following surgery for Crohn's disease with intestinal anastomosis.
All patients receiving biologicals and undergoing abdominal surgery with anastomosis or strictureplasty were identified at six tertiary referral centres. Demographic data, and preoperative, operative and postoperative details were registered. Patients who were treated with biologicals within 2 months before surgery were compared with a control group who were not. Postoperative complications were classified according to anastomotic, infectious or other complications, and graded according to the Clavien-Dindo classification.
Some 111 patients treated with biologicals within 2 months before surgery were compared with 187 patients in the control group. The groups were well matched. There were no differences between the treatment and control groups in the rate of complications of any type (34·2 versus 28·9 per cent respectively; P = 0·402), anastomotic complications (7·2 versus 8·0 per cent; P = 0·976) and non-anastomotic infectious complications (16·2 versus 13·9 per cent; P = 0·586). In univariable regression analysis, biologicals were not associated with an increased risk of any complication (odds ratio (OR) 1·33, 95 per cent confidence interval 0·81 to 2·20), anastomotic complication (OR 0·89, 0·37 to 2·17) or infectious complication (OR 1·09, 0·62 to 1·91).
Treatment with biologicals within 2 months of surgery for Crohn's disease with intestinal anastomosis was not associated with an increased risk of complications.
生物疗法（生物制剂）在克罗恩病的治疗中已得到广泛应用。本研究旨在确定在接受腹部手术（吻合术或狭窄成形术）的克罗恩病患者中，术前使用生物制剂是否会增加术后并发症的发生率。
在六个三级转诊中心，确定了所有接受生物制剂治疗且行腹部吻合术或狭窄成形术的患者。记录患者的人口统计学数据以及术前、术中和术后的详细信息。将术前 2 个月内接受生物制剂治疗的患者与未接受生物制剂治疗的对照组进行比较。根据吻合口、感染或其他并发症对术后并发症进行分类，并根据 Clavien-Dindo 分级进行分级。
将 111 例在术前 2 个月内接受生物制剂治疗的患者与对照组的 187 例患者进行比较，两组患者的情况基本匹配。治疗组和对照组在任何类型并发症的发生率（分别为 34.2%和 28.9%；P=0.402）、吻合口并发症（分别为 7.2%和 8.0%；P=0.976）和非吻合口感染性并发症（分别为 16.2%和 13.9%；P=0.586）方面均无差异。在单变量回归分析中，生物制剂与任何并发症的发生风险增加无关（比值比（OR）1.33，95%置信区间 0.81 至 2.20）、吻合口并发症（OR 0.89，0.37 至 2.17）或感染性并发症（OR 1.09，0.62 至 1.91）。
在接受克罗恩病肠吻合术的患者中，术前 2 个月内使用生物制剂与并发症风险增加无关。
