Nordenvall Caroline, Olén Ola, Nilsson Per J, Ekbom Anders, Bottai Matteo, Myrelid Pär
Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden Center for Digestive Disease, Division of Coloproctology, Karolinska University Hospital, Stockholm, Sweden
Clinical Epidemiology Unit, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden Department of Pediatric Gastroenterology and Nutrition, Sachs' Children's Hospital, Stockholm, Sweden.
J Crohns Colitis. 2016 Oct;10(10):1165-71. doi: 10.1093/ecco-jcc/jjw073. Epub 2016 Mar 14.
Previous studies describing the cumulative failure rate after reconstructive surgery in patients with inflammatory bowel disease have been restricted to specific hospitals, and the generalizability of these results in a population-based setting is unknown. The aim of this study was to investigate the cumulative failure rate and risk factors for failure after reconstructive surgery in patients with inflammatory bowel disease.
The study cohort includes all patients with inflammatory bowel disease in Sweden who underwent colectomy in 2000 through 2013 who were later treated with reconstructive surgery with ileal pouch-anal anastomosis or ileorectal anastomosis. Each patient was followed from admission for reconstructive surgery until admission for failure (a diverting stoma or permanent stoma), date of death, migration or December 31, 2013. Cumulative failure distributions were obtained with the Kaplan-Meier method, and multivariable Cox regression models were used to calculate the risk of failure.
Of the 1809 patients with inflammatory bowel disease treated with colectomy and reconstructive surgery, 83% had ulcerative colitis. During follow-up, 270 patients failed, and the cumulative failure rate was 4.1%, 13.2%, and 15.3% after 1, 3, and 5 years, respectively. The risk of failure was lower after treatment with ileal pouch-anal anastomosis than with ileorectal anastomosis [hazard ratio (95% confidence interval): 0.72 (0.56-0.93)]. Gender, hospital volume, and timing of reconstruction were not significantly associated with the risk of failure.
The 5-year cumulative failure rate in a nationwide setting was 15.3%, and hospital volume was not associated with the risk of failure.
以往描述炎症性肠病患者重建手术后累积失败率的研究仅限于特定医院，这些结果在基于人群的环境中的可推广性尚不清楚。本研究的目的是调查炎症性肠病患者重建手术后的累积失败率及失败的危险因素。
研究队列包括2000年至2013年在瑞典接受结肠切除术且随后接受回肠贮袋肛管吻合术或回肠直肠吻合术重建手术的所有炎症性肠病患者。对每位患者从重建手术入院开始随访，直至因失败（造口转流或永久性造口）入院、死亡、移民或2013年12月31日。采用Kaplan-Meier方法获得累积失败分布，并使用多变量Cox回归模型计算失败风险。
在1809例接受结肠切除术和重建手术的炎症性肠病患者中，83%患有溃疡性结肠炎。随访期间，270例患者失败，1年、3年和5年后的累积失败率分别为4.1%、13.2%和15.3%。回肠贮袋肛管吻合术治疗后的失败风险低于回肠直肠吻合术[风险比（95%置信区间）：0.72（0.56 - 0.93）]。性别、医院规模和重建时机与失败风险无显著相关性。
在全国范围内，5年累积失败率为15.3%，医院规模与失败风险无关。
