Yaari Shaul, Benson Ariel, Aviran Eyal, Lev Cohain Naama, Oren Ran, Sosna Jacob, Israeli Eran
Shaul Yaari, Ariel Benson, Eyal Aviran, Ran Oren, Eran Israeli, IBD Unit, Institute of Gastroenterology and Liver Diseases, Hadassah-Hebrew University Medical Center, Jerusalem 91120, Israel.
World J Gastroenterol. 2016 Dec 21;22(47):10380-10387. doi: 10.3748/wjg.v22.i47.10380.
To characterize radiological and clinical factors associated with subsequent surgical intervention in Crohn's disease (CD) patients with intra-abdominal fistulae.
From a cohort of 1244 CD patients seen over an eight year period (2006 to 2014), 126 patients were identified as having intra-abdominal fistulae, and included in the study. Baseline patient information was collected from the medical records. Imaging studies were assessed for: anatomic type and number of fistulae; diameter of the inflammatory conglomerate; length of diseased bowel; presence of a stricture with pre-stenotic dilatation; presence of an abscess; lymphadenopathy; and the degree of bowel enhancement. Multivariate analysis for the prediction of abdominal surgery was calculated Generalized Linear Models.
In total, there were 193 fistulae in 132 patients, the majority (52%) being entero-enteric. Fifty-nine (47%) patients underwent surgery within one year of the imaging study, of which 36 (29%) underwent surgery within one month. Radiologic features that were associated with subsequent surgery included: multiple fistulae ( = 0.009), presence of stricture ( = 0.02), and an entero-vesical fistula ( = 0.01). Evidence of an abscess, lymphadenopathy, or intense bowel enhancement as well as C-reactive protein levels was not associated with an increased rate of surgery. Patients who were treated after the imaging study with combination immunomodulatory and anti-TNF therapy had significantly lower rates of surgery ( = 0.01). In the multivariate analysis, presence of a stricture [RR 4.5 (1.23-16.3), = 0.02] was the only factor that increased surgery rate.
A bowel stricture is the only factor predicting an increased rate of surgery. Radiological parameters may guide in selecting treatment options in patients with fistulizing CD.
明确腹腔内瘘管形成的克罗恩病（CD）患者后续手术干预相关的放射学及临床因素。
在8年期间（2006年至2014年）诊治的1244例CD患者队列中，确定126例有腹腔内瘘管形成并纳入本研究。从病历中收集患者基线信息。对影像学检查评估以下内容：瘘管的解剖类型和数量；炎性包块直径；病变肠段长度；存在伴有狭窄前扩张的狭窄；存在脓肿；淋巴结病；以及肠强化程度。采用广义线性模型计算预测腹部手术的多变量分析。
132例患者共有193处瘘管，其中大多数（52%）为肠-肠瘘。59例（47%）患者在影像学检查后1年内接受手术，其中36例（29%）在1个月内接受手术。与后续手术相关的放射学特征包括：多发瘘管（P = 0.009）、存在狭窄（P = 0.02）和肠-膀胱瘘（P = 0.01）。脓肿、淋巴结病或肠强化明显的证据以及C反应蛋白水平与手术率增加无关。影像学检查后接受免疫调节和抗TNF联合治疗的患者手术率显著较低（P = 0.01）。在多变量分析中，存在狭窄[相对风险4.5（1.23 - 16.3），P = 0.02]是增加手术率的唯一因素。
肠狭窄是预测手术率增加的唯一因素。放射学参数可指导选择瘘管形成型CD患者的治疗方案。
