Angriman I, Pirozzolo G, Bardini R, Cavallin F, Castoro C, Scarpa M
Department of Surgical, Gastroenterological and Oncological Sciences, University of Padova, Padova, Italy.
Oesophageal and Digestive Tract Surgical Unit, Veneto Institute of Oncology IOV-IRCCS, Padova, Italy.
Colorectal Dis. 2017 Aug;19(8):e279-e287. doi: 10.1111/codi.13769.
Surgical management of colonic Crohn's disease (CD) is still unclear because different procedures can be adopted. The choice of operation is dependent on the involvement of colonic disease but the advantages and disadvantages of the extent of resection are still debated.
The aim of the present study was to evaluate the differences in short-term and long-term outcomes of adult patients with colonic CD who underwent either subtotal colectomy and ileorectal anastomosis (STC) or segmental colectomy (SC) or total proctocolectomy and end ileostomy (TPC). Studies published between 1984 and 2012 including comparisons of STC vs SC and of STC vs TPC were selected. The study end-points were overall and surgical recurrence, postoperative morbidity and incidence of permanent stoma. Fixed effect models were used to evaluate the study outcomes.
Eleven studies, consisting of a total of 1436 patients (510 STC, 500 SC and 426 TPC), were included. Analysis of the data showed no significant difference between STC and SC in terms of overall and surgical recurrence of CD. In contrast, STC showed a higher risk of overall and surgical recurrence of CD than TPC (OR 3.53, 95% CI 2.45-5.10, P < 0.0001; OR 3.52, 95% CI 2.27-5.44, P < 0.0001, respectively). SC had a higher risk of postoperative complications compared to STC, and STC had a lower risk of complications than TPC (OR 2.84, 95% CI 1.16-6.96, P < 0.02; OR 0.19, 95% CI 0.09-0.38, P < 0.0001, respectively). SC resulted in a lower risk of permanent stoma than STC (OR 0.52, 95% CI 0.35-0.77).
All three procedures were equally effective as treatment options for colonic CD and the choice of operation remains intrinsically dependent on the extent of colonic disease. However, patients in the TPC group showed a lower recurrence risk than those in the STC group. Moreover, SC had a higher risk of postoperative complications but a lower risk of permanent stoma. These data should be taken into account when deciding surgical strategies and when informing patients about postoperative risks.
由于可采用不同的手术方式，结肠克罗恩病（CD）的外科治疗仍不明确。手术方式的选择取决于结肠疾病的累及范围，但切除范围的优缺点仍存在争议。
本研究的目的是评估接受次全结肠切除术和回直肠吻合术（STC）、节段性结肠切除术（SC）或全直肠结肠切除术和末端回肠造口术（TPC）的成年结肠CD患者的短期和长期结局差异。选择1984年至2012年间发表的包括STC与SC以及STC与TPC比较的研究。研究终点为总体复发率和手术复发率、术后发病率及永久性造口发生率。采用固定效应模型评估研究结局。
纳入11项研究，共1436例患者（510例行STC，500例行SC，426例行TPC）。数据分析显示，STC和SC在CD的总体复发率和手术复发率方面无显著差异。相比之下，STC的CD总体复发率和手术复发率高于TPC（OR 3.53，95%CI 2.45 - 5.10，P < 0.0001；OR 3.52，95%CI 2.27 - 5.44，P < 0.0001）。SC术后并发症风险高于STC，而STC并发症风险低于TPC（OR 2.84，95%CI 1.16 - 6.96，P < 0.02；OR 0.19，95%CI 0.09 - 0.38，P < 0.0001）。SC导致永久性造口的风险低于STC（OR 0.52，95%CI 0.35 - 0.77）。
所有这三种手术方式作为结肠CD的治疗选择同样有效，手术方式的选择本质上仍取决于结肠疾病的范围。然而，TPC组患者的复发风险低于STC组。此外，SC术后并发症风险较高，但永久性造口风险较低。在决定手术策略以及告知患者术后风险时应考虑这些数据。
