Koriche Dine, Gower-Rousseau Corinne, Chater Charbel, Duhamel Alain, Salleron Julia, Tavernier Noémie, Colombel Jean-Frédéric, Pariente Benjamin, Cortot Antoine, Zerbib Philippe
Digestive Surgery and Transplantation Unit, Hôpital Huriez, Lille Nord de France University, Lille University Medical Center, F-59000, Lille, France.
Lille Inflammation Research International Center LIRIC-UMR 995 Inserm, Université Lille 2/CHRU de Lille; Equipe « IBD and environmental factors: Epidemiology and functional analyses, Lille University, Lille, France.
Int J Colorectal Dis. 2017 Apr;32(4):453-458. doi: 10.1007/s00384-016-2707-2. Epub 2016 Nov 24.
Crohn's disease (CD) is a progressive inflammatory disease affecting the entire gastrointestinal tract. The need for a definitive stoma (DS) is considered as the ultimate phase of damage. It is often believed that the risk of further disease progression is small when a DS has been performed.
The goals of the study were to establish the rate of CD recurrence above the DS and to identify predictive factors of CD recurrence at the time of DS.
We retrospectively reviewed all medical records of consecutive CD patients having undergone DS between 1973 and 2010. We collected clinical data at diagnosis, CD phenotype, treatment, and surgery after DS and mortality. Stoma was considered as definitive when restoration of continuity was not possible due to proctectomy, rectitis, anoperineal lesions (APL), or fecal incontinence. Clinical recurrence (CR) was defined as the need for re-introduction or intensification of medical therapy, and surgical recurrence (SR) was defined as a need for a new intestinal resection.
Eighty-three patients (20 males, 63 females) with a median age of 34 years at CD diagnosis were included. The median time between diagnosis and DS was 9 years. The median follow-up after DS was 10 years. Thirty-five patients (42%) presented a CR after a median time of 28 months (2-211) and 32 patients (38%) presented a SR after a median time of 29 months (4-212). In a multivariate analysis, APL (HR = 5.1 (1.2-21.1), p = 0.03) and colostomy at time of DS (HR = 3.8 (1.9-7.3), p = 0.0001) were associated factors with the CR.
After DS for CD, the risk of clinical recurrence was high and synonymous with surgical recurrence, especially for patients with APL and colostomy.
克罗恩病（CD）是一种影响整个胃肠道的进行性炎症性疾病。永久性造口（DS）的需求被视为损害的最终阶段。人们通常认为，在进行DS后，疾病进一步进展的风险很小。
本研究的目的是确定DS上方CD复发的发生率，并确定DS时CD复发的预测因素。
我们回顾性分析了1973年至2010年间连续接受DS的CD患者的所有病历。我们收集了诊断时的临床数据、CD表型、治疗、DS后的手术情况以及死亡率。当由于直肠切除术、直肠炎、肛门会阴病变（APL）或大便失禁而无法恢复肠道连续性时，造口被视为永久性的。临床复发（CR）定义为需要重新引入或强化药物治疗，手术复发（SR）定义为需要进行新的肠道切除术。
纳入了83例患者（20例男性，63例女性），CD诊断时的中位年龄为34岁。诊断与DS之间的中位时间为9年。DS后的中位随访时间为10年。35例患者（42%）在中位时间28个月（2 - 211个月）后出现CR，32例患者（38%）在中位时间29个月（4 - 212个月）后出现SR。在多变量分析中，APL（HR = 5.1（1.2 - 21.1），p = 0.03）和DS时的结肠造口（HR = 3.8（1.9 - 7.3），p = 0.0001）是与CR相关的因素。
CD患者进行DS后，临床复发风险很高，且与手术复发同义，尤其是对于患有APL和结肠造口的患者。
