Fumery Mathurin, Seksik Philippe, Auzolle Claire, Munoz-Bongrand Nicolas, Gornet Jean-Marc, Boschetti Gilles, Cotte Eddy, Buisson Anthony, Dubois Anne, Pariente Benjamin, Zerbib Philippe, Chafai Najim, Stefanescu Carmen, Panis Yves, Marteau Philippe, Pautrat Karine, Sabbagh Charles, Filippi Jerome, Chevrier Marc, Houze Pascal, Jouven Xavier, Treton Xavier, Allez Matthieu
Department of Gastroenterology, Amiens University Hospital, University Picardie Jules Verne, Amiens, France.
Sorbonne Universites, UPMC Univ Paris 06, Ecole Normale Superieure, CNRS, INSERM, ERL 1157, LBM, APHP, Gastroenterology Unit, Saint Antoine Hospital, Paris, France.
Am J Gastroenterol. 2017 Feb;112(2):337-345. doi: 10.1038/ajg.2016.541. Epub 2016 Dec 13.
We sought to determine the frequency of and risk factors for early (30-day) postoperative complications after ileocecal resection in a well-characterized, prospective cohort of Crohn's disease patients.
The REMIND group performed a nationwide study in 9 French university medical centers. Clinical-, biological-, surgical-, and treatment-related data on the 3 months before surgery were collected prospectively. Patients operated on between 1 September 2010 and 30 August 2014 were included.
A total of 209 patients were included. The indication for ileocecal resection was stricturing disease in 109 (52%) cases, penetrating complications in 88 (42%), and medication-refractory inflammatory disease in 12 (6%). A two-stage procedure was performed in 33 (16%) patients. There were no postoperative deaths. Forty-three (21%) patients (23% of the patients with a one-stage procedure vs. 9% of those with a two-stage procedure, P=0.28) experienced a total of 54 early postoperative complications after a median time interval of 5 days (interquartile range, 4-12): intra-abdominal septic complications (n=38), extra-intestinal infections (n=10), and hemorrhage (n=6). Eighteen complications (33%) were severe (Dindo-Clavien III-IV). Reoperation was necessary in 14 (7%) patients, and secondary stomy was performed in 8 (4.5%). In a multivariate analysis, corticosteroid treatment in the 4 weeks before surgery was significantly associated with an elevated postoperative complication rate (odds ratio (95% confidence interval)=2.69 (1.15-6.29); P=0.022). Neither preoperative exposure to anti-tumor necrosis factor (TNF) agents (n=93, 44%) nor trough serum anti-TNF levels were significant risk factors for postoperative complications.
In this large, nationwide, prospective cohort, postoperative complications were observed after 21% of the ileocecal resections. Corticosteroid treatment in the 4 weeks before surgery was significantly associated with an elevated postoperative complication rate. In contrast, preoperative anti-TNF therapy (regardless of the serum level or the time interval between last administration and surgery) was not associated with an elevated risk of postoperative complications.
我们试图在一个特征明确的克罗恩病患者前瞻性队列中，确定回盲部切除术后早期（30天）并发症的发生率及危险因素。
REMIND组在法国9家大学医学中心开展了一项全国性研究。前瞻性收集术前3个月的临床、生物学、手术及治疗相关数据。纳入2010年9月1日至2014年8月30日期间接受手术的患者。
共纳入209例患者。回盲部切除的指征为狭窄性疾病109例（52%），穿透性并发症88例（42%），药物难治性炎症性疾病12例（6%）。33例（16%）患者接受了两阶段手术。无术后死亡病例。43例（21%）患者（一期手术患者中的23% vs. 二期手术患者中的9%，P = 0.28）在中位时间间隔5天（四分位间距，4 - 12天）后共发生54例早期术后并发症：腹腔感染性并发症（n = 38）、肠外感染（n = 10）及出血（n = 6）。18例并发症（33%）为严重并发症（Dindo-Clavien III - IV级）。14例（7%）患者需要再次手术，8例（4.5%）患者进行了二期造口术。多因素分析显示，术前4周使用皮质类固醇治疗与术后并发症发生率升高显著相关（比值比（95%置信区间）= 2.69（1.15 - 6.29）；P = 0.022）。术前使用抗肿瘤坏死因子（TNF）药物（n = 93，44%）及血清抗TNF谷值水平均不是术后并发症的显著危险因素。
在这个大型的全国性前瞻性队列中，21%的回盲部切除术后观察到了术后并发症。术前4周使用皮质类固醇治疗与术后并发症发生率升高显著相关。相比之下，术前抗TNF治疗（无论血清水平或末次给药与手术之间的时间间隔）与术后并发症风险升高无关。
