Departments of Surgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
Departments of Gastroenterology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
Inflamm Bowel Dis. 2019 Aug 20;25(9):1559-1568. doi: 10.1093/ibd/izz010.
Many patients with Crohn's disease (CD) are treated with medications, including steroids, immunomodulators, and anti-tumor necrosis factor alpha (anti-TNF-α) agents, at the time of surgery. This study evaluated the effects of these medications on postoperative complications in CD patients.
This retrospective study analyzed patients who underwent bowel resection for CD between January 2006 and December 2015. Postoperative complications were defined as a Clavien-Dindo classification of grade 2A or higher within the first 30 days after surgery.
Of the 817 patients enrolled, 687 patients received bowel resection and anastomosis without stoma formation. Of 687 patients, 381 (55.5%) were being treated with preoperative medications at the time of surgery (medication group) and 306 (44.5%) were not (nonmedication group). The overall rate of postoperative complications was not different between the medication and nonmedication groups (23.4% vs 21.9%, P = 0.36). Preoperative treatments with immunomodulators plus anti-TNF-α agents (relative risk [RR], 2.314; 95% confidence interval [CI], 1.126-4.753; P = 0.022) and treatment with immunomodulators plus steroids (RR, 2.536; 95% CI, 1.124-5.725; P = 0.025) were risk factors for infectious complications. Preoperative treatments with immunomodulators plus anti-TNF-α agents (RR, 2.731; 95% CI, 1.102-6.769; P = 0.03) and treatment with immunomodulators plus steroids (RR, 3.118; 95% CI, 1.169-8.320; P = 0.023) were significantly associated with increased risk of intra-abdominal sepsis.
Preoperative treatments with immunomodulators plus anti-TNF-α agents or steroids were risk factors for infectious complications, especially intra-abdominal sepsis in patients who underwent bowel resection and anastomosis.
许多克罗恩病（CD）患者在手术时接受药物治疗，包括皮质类固醇、免疫调节剂和抗肿瘤坏死因子-α（抗-TNF-α）药物。本研究评估了这些药物对 CD 患者术后并发症的影响。
本回顾性研究分析了 2006 年 1 月至 2015 年 12 月期间接受肠切除术治疗 CD 的患者。术后并发症定义为术后 30 天内发生 Clavien-Dindo 分级 2A 或更高的并发症。
在纳入的 817 例患者中，687 例患者接受了无造口形成的肠切除吻合术。在 687 例患者中，381 例（55.5%）在手术时接受了术前药物治疗（药物组），306 例（44.5%）未接受药物治疗（非药物组）。药物组和非药物组的术后并发症总发生率无差异（23.4%比 21.9%，P=0.36）。术前接受免疫调节剂联合抗-TNF-α 药物治疗（相对风险 [RR]，2.314；95%置信区间 [CI]，1.126-4.753；P=0.022）和免疫调节剂联合皮质类固醇治疗（RR，2.536；95%CI，1.124-5.725；P=0.025）是感染性并发症的危险因素。术前接受免疫调节剂联合抗-TNF-α 药物治疗（RR，2.731；95%CI，1.102-6.769；P=0.03）和免疫调节剂联合皮质类固醇治疗（RR，3.118；95%CI，1.169-8.320；P=0.023）与增加腹腔内脓毒症风险显著相关。
术前接受免疫调节剂联合抗-TNF-α 药物或皮质类固醇治疗是感染性并发症的危险因素，尤其是在接受肠切除吻合术的患者中，与腹腔内脓毒症相关。
