Cohen-Mekelburg Shirley, Schneider Yecheskel, Gold Stephanie, Scherl Ellen, Steinlauf Adam
Dr Cohen-Mekelburg and Dr Schneider are gastroenterology fellows, Dr Gold is an internal medicine resident, Dr Scherl is a clinical professor and attending physician, and Dr Steinlauf is an assistant professor and attending physician at NewYork-Presbyterian/Weill Cornell Medical Center in New York, New York.
Gastroenterol Hepatol (N Y). 2017 Nov;13(11):651-658.
Although there have been significant advances in medical therapies to treat Crohn's disease, an estimated 50% of patients will require surgery within the first decade of disease duration. Of these patients, a substantial number will develop recurrent symptoms within the first postoperative year. To prevent disease recurrence, many physicians use postoperative prophylactic therapy. Randomized, controlled trials, although limited in number, have demonstrated that a prophylactic postoperative strategy is effective at reducing recurrence (both clinical and endoscopic) in high-risk patients. This article reviews the frequency of and risk factors for postoperative Crohn's disease recurrence and the current evidence in favor of postoperative Crohn's disease management strategies. Future studies must be conducted to establish a gold standard as to who should receive postoperative prophylaxis and which therapies and time course are ideal.
尽管在治疗克罗恩病的医学疗法方面已经取得了重大进展，但估计有50%的患者在病程的第一个十年内需要进行手术。在这些患者中，相当一部分人会在术后第一年出现复发症状。为了预防疾病复发，许多医生采用术后预防性治疗。随机对照试验虽然数量有限，但已证明术后预防性策略在降低高危患者的复发率（临床复发和内镜复发）方面是有效的。本文综述了克罗恩病术后复发的频率和危险因素，以及目前支持术后克罗恩病管理策略的证据。必须开展进一步研究，以确立关于哪些患者应接受术后预防、何种治疗方法以及最佳疗程的金标准。
