Guo Zhen, Cao Lei, Guo Feilong, Gong Jianfeng, Li Yi, Gu Lili, Zhu Weiming, Li Jieshou
Department of General Surgery, Jinling Hospital, Medical School of Nanjing University, No. 305 East Zhongshan Road, Nanjing, 210002, People's Republic of China.
World J Surg. 2017 Sep;41(9):2371-2377. doi: 10.1007/s00268-017-4026-3.
The purpose of the study was to identify risk factors for early clinical and surgical recurrence in Crohn's disease (CD) patients who underwent intestinal resection.
This was a retrospective study. Consecutive patients who underwent intestinal resection with a primary anastomosis from January 2011-December 2014 were enrolled. Gender, age at surgery, clinical phenotypes of CD, serum albumin and C-reactive protein level the day before surgery, smoking status at surgery, anastomosis technique, number of anastomoses, details of postoperative complications, the postoperative prophylactic treatment were assessed to figure out risk factors for postoperative clinical and surgical recurrence within 1 year after the initial resection by univariate and then multivariate analysis.
Two hundred and thirty-seven patients were analyzed. The risk of early postoperative clinical recurrence was 2.99 times higher in patients suffered postoperative infectious complications [odds ratio (OR) 2.99; 95% CIs, 1.42-6.32; p = 0.004], while never-smoking was found to be a protective factor for early clinical recurrence (OR 0.326; 95% CIs, 0.18-0.59; p < 0.0001). For surgical recurrence within 1 year after resection, the presence of postoperative intra-abdominal septic complications might be a risk factor (OR 6.77; 95% CIs, 1.61-28.5; p = 0.009). Smoker at surgery was also a risk factor for early surgical recurrence (OR 5.41; 95% CIs, 1.36-21.5; p = 0.017).
The presence of postoperative infectious complications was identified as a possible risk factor for early postoperative clinical recurrence after resection in CD patients.
本研究的目的是确定接受肠切除的克罗恩病（CD）患者早期临床和手术复发的风险因素。
这是一项回顾性研究。纳入了2011年1月至2014年12月期间接受肠切除并进行一期吻合的连续患者。评估患者的性别、手术时年龄、CD的临床表型术前一天的血清白蛋白和C反应蛋白水平、手术时的吸烟状况、吻合技术、吻合口数量、术后并发症细节、术后预防性治疗情况，通过单因素分析然后多因素分析来找出初次切除术后1年内术后临床和手术复发的风险因素。
共分析了237例患者。术后发生感染性并发症的患者术后早期临床复发风险高2.99倍[比值比（OR）2.99；95%置信区间（CI），1.42 - 6.32；P = 0.004]，而从不吸烟被发现是早期临床复发的保护因素（OR 0.326；95% CI，0.18 - 0.59；P < 0.0001）。对于切除术后1年内的手术复发，术后腹腔内感染性并发症的存在可能是一个风险因素（OR 6.77；95% CI，1.61 - 28.5；P = 0.009）。手术时吸烟也是早期手术复发的风险因素（OR 5.41；95% CI，1.36 - 21.5；P = 0.017）。
术后感染性并发症的存在被确定为CD患者切除术后早期临床复发的一个可能风险因素。
