Scarpa Marco, Martinato Matteo, Bertin Eugenia, Da Roit Anna, Pozza Anna, Ruffolo Cesare, D'Incà Renata, Bardini Romeo, Castoro Carlo, Sturniolo Giacomo C, Angriman Imerio
Oncological Surgery Unit, Veneto Institute of Oncology (IOV-IRCCS), Padova, Italy.
Dig Surg. 2015;32(4):243-50. doi: 10.1159/000381885. Epub 2015 May 19.
Patients affected by Crohn's disease (CD) require lifelong medical therapy, but they can also often require abdominal surgery. The effect of CD therapy on postoperative course is still unclear. The aim of this study was to evaluate the effect of preoperative medical therapy on the outcome of intestinal surgery in these patients.
Data from a consecutive series of 167 patients with CD operated on at the University of Padova Hospital from 2000 to 2013 were retrieved. Data of preoperative therapy during the 6 months before surgery were available for 146 patients who were enrolled in this retrospective study. Clinical data and surgical details were retrieved and postoperative complications and reoperation were considered outcome measures. Univariate and multivariate analysis were performed.
No significant difference was observed between patients without data about their preoperative therapy and those with them. Eight patients underwent reoperation in the first 30 postoperative days: two of them for anastomotic leak, three for bleeding, one for obstruction and two for abdominal wound dehiscence. At multivariate analysis, preoperative adalimumab and budesonide resulted to be an independent predictor of reoperation (OR = 7.67 (95% CI = 1.49-39.20), p = 0.01 and OR = 6.7749 (95% CI = 0.98-46.48), p = 0.05, respectively). At multivariate analysis neither pharmacological nor clinical variables resulted to predict anastomotic leak.
In our series, adalimumab seemed to be associated to early reoperation after intestinal surgery. This may be due to a worst disease severity in patients who needed surgery in spite of biological therapy. Preoperative tapering of budesonide dose seems a safe option before elective abdominal surgery for CD.
克罗恩病（CD）患者需要终身药物治疗，但他们也常常需要接受腹部手术。CD治疗对术后病程的影响仍不明确。本研究的目的是评估术前药物治疗对这些患者肠道手术结局的影响。
检索了2000年至2013年在帕多瓦大学医院接受手术的167例连续性CD患者的数据。146例患者有术前6个月的治疗数据，纳入本回顾性研究。收集临床数据和手术细节，将术后并发症和再次手术作为结局指标。进行单因素和多因素分析。
术前治疗数据缺失的患者与有数据的患者之间未观察到显著差异。8例患者在术后30天内接受了再次手术：其中2例因吻合口漏，3例因出血，1例因梗阻，2例因腹部伤口裂开。多因素分析显示，术前使用阿达木单抗和布地奈德是再次手术的独立预测因素（OR分别为7.67（95%CI=1.49-39.20），p=0.01和OR=6.7749（95%CI=0.98-46.48），p=0.05）。多因素分析显示，无论是药理学变量还是临床变量均不能预测吻合口漏。
在我们的研究系列中，阿达木单抗似乎与肠道手术后早期再次手术有关。这可能是由于尽管接受了生物治疗仍需手术的患者疾病严重程度更差。术前逐渐减少布地奈德剂量似乎是CD择期腹部手术前的一个安全选择。
