Inflammatory Bowel Disease Unit, SETOC, St Mark's Hospital, Harrow,UK Department of Surgery and Cancer, Imperial College London, London, UK.
Inflammatory Bowel Disease Unit, SETOC, St Mark's Hospital, Harrow,UK.
J Crohns Colitis. 2015 Jun;9(6):483-91. doi: 10.1093/ecco-jcc/jjv051. Epub 2015 Mar 21.
Intra-abdominal septic complications [IASC] following ileocolonic resection for Crohn's disease are common. Determining risk factors for these complications can aid pre-operative and peri-operative strategies to reduced morbidity. This study aims to determine the incidence and predictors of intra-abdominal septic complications following ileocolonic resection for Crohn's disease.
A single-centre, retrospective study was conducted. The clinical case notes of patients with histopathologically proven Crohn's disease, who underwent an ileocolonic resection as a one-stage or two-stage procedure, were reviewed. The primary endpoint was the formation of intra-abdominal septic complications within a 30-day post-operative time frame.
Overall 163 patients underwent 175 ileocolonic procedures. Post-operative intra-abdominal septic complications were demonstrated in 9% [13/142] of one-stage procedures and 12% [4/33] of two-stage procedures [p = 0.2]. Post-operative IASCs following a one-stage procedure demonstrated associations with smokers [p = 0.004], intraoperative abdominal sepsis [p = 0.005], concomitant upper gastrointestinal Crohn's [p = 0.015], the presence of peri-operative anaemia [p = 0.037], hypoalbuminaemia [< 25g/l] [p = 0.04], and histologically involved margins [p = 0.001]. Multivariate analysis demonstrated the presence of intra-abdominal sepsis (hazard ratio [HR] 8.6, 95% confidence interval [CI]: 1.2 60.1] and the use of peri-operative biologicals [HR 24.6, 95% CI: 2.0-298] as independent predictors of post-operative intra-abdominal septic complications.
This study highlights specific variables that may be contributory to poor outcome. These findings may be important when optimising patients for surgery, as well as planning an appropriate operative strategy. Further prospective studies and a larger sample size are required to validate these findings.
克罗恩病患者行回肠结肠切除术（ileocolonic resection）后，常并发腹腔内感染性并发症（intra-abdominal septic complications，IASC）。明确这些并发症的危险因素有助于制定术前和围手术期策略，以降低发病率。本研究旨在确定克罗恩病患者行回肠结肠切除术后发生腹腔内感染性并发症的发生率和预测因素。
这是一项单中心回顾性研究。对经组织病理学证实的克罗恩病患者的临床病历进行了回顾性分析，这些患者接受了一期或两期回肠结肠切除术。主要终点是术后 30 天内发生腹腔内感染性并发症。
共有 163 例患者接受了 175 次回肠结肠手术。一期手术中，9%（13/142）出现术后腹腔内感染性并发症，两期手术中为 12%（4/33），两组间无显著差异（p = 0.2）。一期手术后发生术后腹腔内 IASC 与吸烟者（p = 0.004）、术中腹腔感染（p = 0.005）、同时存在上消化道克罗恩病（p = 0.015）、围手术期贫血（p = 0.037）、低白蛋白血症（<25g/l）（p = 0.04）和组织学上受累的切缘（p = 0.001）相关。多因素分析显示，腹腔内感染（危险比[HR] 8.6，95%置信区间[CI]：1.2-60.1）和围手术期使用生物制剂（HR 24.6，95%CI：2.0-298）是术后发生腹腔内感染性并发症的独立预测因素。
本研究强调了可能导致不良结局的特定变量。这些发现对于优化患者手术治疗和规划适当的手术策略可能很重要。需要进一步的前瞻性研究和更大的样本量来验证这些发现。
