Geltzeiler Cristina B, Hart Kyle D, Lu Kim C, Deveney Karen E, Herzig Daniel O, Tsikitis Vassiliki L
Department of Surgery, Division of Colorectal Surgery, Oregon Health & Science University, 3181 S.W. Sam Jackson Park Rd., Mail Code L223A, 97239, Portland, OR, USA.
J Gastrointest Surg. 2015 Oct;19(10):1862-8. doi: 10.1007/s11605-015-2911-3. Epub 2015 Aug 19.
Although medical management of Crohn's disease has changed in recent years, it is unclear whether surgical management has altered. We examined rate changes of surgical interventions, stoma constructions, and subset of ileostomy and colostomy constructions.
We reviewed the Nationwide Inpatient Sample database from 1988 to 2011. We examined the number of Crohn's-related operations and stoma constructions, including ileostomies and colostomies; a multivariable logistic regression model was developed.
A total of 355,239 Crohn's-related operations were analyzed. Operations increased from 13,955 in 1988 to 17,577 in 2011, p < 0.001. Stoma construction increased from 2493 to 4283, p < 0.001. The subset of ileostomies increased from 1201 to 3169, p < 0.001 while colostomies decreased from 1351 to 1201, p = 0.05. Operation percentages resulting in stoma construction increased from 18 to 24 %, p < 0.001. Weight loss (OR 2.25, 95 % CI 1.88, 2.69) and presence of perianal fistulizing disease (OR 2.91, 95 % CI 2.31, 3.67) were most predictive for requiring stoma construction.
Crohn's-related surgical interventions and stoma constructions have increased. The largest predictors for stoma construction are weight loss and perianal fistulizing disease. As a result, nutrition should be optimized and the early involvement of a multidisciplinary team should be considered.
尽管近年来克罗恩病的药物治疗有所改变，但手术治疗是否发生变化尚不清楚。我们研究了手术干预、造口术以及回肠造口术和结肠造口术亚组的发生率变化。
我们回顾了1988年至2011年的全国住院患者样本数据库。我们研究了克罗恩病相关手术和造口术的数量，包括回肠造口术和结肠造口术；建立了多变量逻辑回归模型。
共分析了355239例克罗恩病相关手术。手术数量从1988年的13955例增加到2011年的17577例，p<0.001。造口术从2493例增加到4283例，p<0.001。回肠造口术亚组从1201例增加到3169例，p<0.001，而结肠造口术从1351例减少到1201例，p=0.05。导致造口术的手术百分比从18%增加到24%，p<0.001。体重减轻（OR 2.25，95%CI 1.88，2.69）和肛周瘘管病（OR 2.91，95%CI 2.31，3.67）是最能预测需要造口术的因素。
克罗恩病相关的手术干预和造口术有所增加。造口术的最大预测因素是体重减轻和肛周瘘管病。因此，应优化营养，并考虑多学科团队的早期介入。
