Fornaro Rosario, Caratto Elisa, Caratto Michela, Fornaro Francesco, Caristo Giuseppe, Frascio Marco, Sticchi Camilla
University of Genoa, Department of Surgery, IRCCS San Martino Hospital IST, Largo Rosanna Benzi n 10, 16132 Genova, Italy.
University of Genoa, Department of Surgery, IRCCS San Martino Hospital IST, Largo Rosanna Benzi n 10, 16132 Genova, Italy.
Surgeon. 2015 Dec;13(6):330-47. doi: 10.1016/j.surge.2015.04.002. Epub 2015 Jun 3.
Crohn's disease is associated with high rates of postoperative recurrence. At 10 years after surgery a high percentage of patients suffer recurrence (as many as 75% and above) and many of these (up to 45%) require re-intervention. The aim of the study was to identify, amongst the various "potential predictive factors", those which today should be considered "real risk factors" for postoperative recurrence.
A review of literature of the last 30 years was carried out. A medical literature search was conducted using Medline, Embase, Ovid Journals, Science Direct, the Cochrane Central Register of Controlled Trials and the Cochrane Database of Systematic Reviews. Potential risk factors related to the patient, disease, type of surgery and pharmacological treatment were analyzed.
According to most Authors predictive factors, in addition to smoke, are also represented by an extent of disease superior to 100 cm and by absence of postoperative pharmacological treatment. Moreover, according to "the second European evidence-based Consensus on the diagnosis and the management of Crohn's disease: Special situations", localization of disease in the colon, penetrative behavior of disease, extensive small bowel resection and prior intestinal surgery should also be considered predictive factors.
The high incidence of postoperative recurrence in Crohn's disease mandates a strict follow up (clinical, laboratory and instrumental monitoring). Identifying patients with increased risk would enable physicians to plan a surveillance program and to implement a rational therapeutic prophylaxis.
克罗恩病与术后高复发率相关。术后10年，高比例患者会出现复发（高达75%及以上），其中许多患者（高达45%）需要再次干预。本研究的目的是在各种“潜在预测因素”中，确定目前应被视为术后复发“真正危险因素”的因素。
对过去30年的文献进行综述。使用医学在线数据库（Medline）、荷兰医学文摘数据库（Embase）、Ovid期刊数据库、科学Direct数据库、Cochrane对照试验中央注册库和Cochrane系统评价数据库进行医学文献检索。分析了与患者、疾病、手术类型和药物治疗相关的潜在危险因素。
根据大多数作者的观点，除吸烟外，预测因素还包括病变范围超过100 cm以及术后未进行药物治疗。此外，根据“欧洲关于克罗恩病诊断和治疗的第二次循证共识：特殊情况”，病变位于结肠、疾病穿透行为、广泛小肠切除和既往肠道手术也应被视为预测因素。
克罗恩病术后复发的高发生率要求进行严格的随访（临床、实验室和仪器监测）。识别风险增加的患者将使医生能够制定监测计划并实施合理的治疗预防措施。
