Bafford Andrea C, Latushko Anastasiya, Hansraj Natasha, Jambaulikar Guruprasad, Ghazi Leyla J
Department of Surgery, University of Maryland, 22 South Greene Street, Baltimore, MD, 21201, USA.
Veterans Affairs, Maryland Heath Care System, Baltimore, MD, USA.
Dig Dis Sci. 2017 Aug;62(8):2079-2086. doi: 10.1007/s10620-017-4618-7. Epub 2017 May 26.
To determine whether temporary fecal diversion for refractory colonic and/or perianal Crohn's disease can lead to clinical remission and restoration of intestinal continuity after optimization of medical therapy.
We retrospectively reviewed our prospectively maintained database of patients treated at the University of Maryland for Crohn's disease between May 2004 and July 2014. Patients with colonic, perianal, or colonic and perianal Crohn's disease, who had fecal diversion for control of medically refractory and/or severe disease, were included. Outcomes, including disease activity and rate of ileostomy reversal, were evaluated up to 24 months from stoma formation.
Thirty patients were identified. Fecal diversion was performed for perianal disease in 37%, colonic disease in 33%, and both in 30% of patients. Twelve (40%) patients underwent ileostomy reversal. Twenty-five percent of patients with perianal disease had their ostomies reversed compared to 70% of patients with colonic disease alone. More patients with complex compared to simple perianal disease remained diverted (p = 0.02). Six (20%) patients required colectomy. Of these, 50% had complex perianal disease, all had received two or more biologics, and two-thirds were on combination therapy pre-diversion.
Our study found that nearly two-thirds of patients with medically refractory colonic and/or severe perianal Crohn's disease treated with fecal diversion and optimization of postoperative medical therapy remain diverted or require colectomy within two years after ileostomy formation. In patients with severe, refractory perianal disease and those treated with combination therapy and >1 biologic exposure pre-diversion, colectomy rather than temporary fecal diversion should be considered.
确定难治性结肠和/或肛周克罗恩病患者在优化药物治疗后进行临时粪便改道是否能实现临床缓解并恢复肠道连续性。
我们回顾性分析了2004年5月至2014年7月在马里兰大学接受治疗的克罗恩病患者的前瞻性维护数据库。纳入患有结肠、肛周或结肠合并肛周克罗恩病且因控制药物难治性和/或严重疾病而进行粪便改道的患者。从造口形成起长达24个月评估包括疾病活动度和回肠造口还纳率在内的结局。
共确定了30例患者。37%的患者因肛周疾病进行粪便改道，33%因结肠疾病，30%因两者均有。12例（40%）患者进行了回肠造口还纳。肛周疾病患者中有25%进行了造口还纳，而仅患有结肠疾病的患者这一比例为70%。与单纯肛周疾病患者相比，复杂性肛周疾病患者中仍需改道的更多（p = 0.02）。6例（20%）患者需要行结肠切除术。其中，50%患有复杂性肛周疾病，均接受过两种或更多生物制剂治疗，三分之二在改道前接受联合治疗。
我们的研究发现，近三分之二接受粪便改道及术后药物治疗优化的药物难治性结肠和/或严重肛周克罗恩病患者在回肠造口形成后两年内仍需改道或需要行结肠切除术。对于严重难治性肛周疾病患者以及改道前接受联合治疗且暴露于一种以上生物制剂的患者，应考虑行结肠切除术而非临时粪便改道。
