现代药物治疗对手术的影响：克罗恩病
Impact of Modern Drug Therapy on Surgery: Crohn's Disease.
作者信息
Kienle Peter
机构信息
Department of Surgery, Theresienkrankenhaus und St. Hedwig-Klinik GmbH, Mannheim, Germany.
出版信息
Visc Med. 2018 Dec;34(6):422-425. doi: 10.1159/000495127. Epub 2018 Nov 30.
BACKGROUND
A significant number of patients with Crohn's disease needs to undergo surgery, and many of these patients are under modern drug treatment. These drugs may influence the rate of perioperative complications. This may have an impact on the chosen surgical strategy.
METHODS
This review considers clinical studies and guidelines on the effect of modern drug treatment on surgical complication rates and surgical strategy in patients with Crohn's disease.
RESULTS
Steroids above a certain dose significantly influence perioperative complications and should therefore be tapered down before performing elective surgery. Anti-TNF-alpha drugs are associated with perioperative complications, and therefore a safe interval between drug intake and surgery should be adhered to. The data on newer biologicals is scarce and conflicting; thus, it seems prudent to wait at least for one dosing interval before operating. In the emergency setting, patients undergoing bowel resection while on the above medications without an adequate interval to the last medication dose should generally get a resectional or diverting stoma.
CONCLUSION
Modern drug treatment influences the surgical strategy in patients with Crohn's disease.
背景
相当数量的克罗恩病患者需要接受手术治疗，其中许多患者正在接受现代药物治疗。这些药物可能会影响围手术期并发症的发生率。这可能会对所选的手术策略产生影响。
方法
本综述考虑了关于现代药物治疗对克罗恩病患者手术并发症发生率和手术策略影响的临床研究及指南。
结果
超过一定剂量的类固醇会显著影响围手术期并发症，因此在进行择期手术前应逐渐减量。抗TNF-α药物与围手术期并发症有关，因此应遵守药物摄入与手术之间的安全间隔。关于新型生物制剂的数据稀少且相互矛盾；因此，在手术前至少等待一个给药间隔似乎是谨慎的做法。在紧急情况下，正在服用上述药物且距离上次服药剂量没有足够间隔时间的患者接受肠道切除手术时，通常应进行切除性或转流性造口术。
结论
现代药物治疗会影响克罗恩病患者的手术策略。
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