Université de Paris, Institut de Recherche Saint Louis, EMiLy, Inserm U1160, F-75010 Paris, France; Departement de Gastroentérologie, AP-HP, Hôpital Saint-Louis, F-75010 Paris, France.
Pathology Department, AP-HP, Hôpital Beaujon, Clichy, France.
Clin Gastroenterol Hepatol. 2020 Jan;18(1):141-149.e2. doi: 10.1016/j.cgh.2019.04.045. Epub 2019 Apr 28.
Different types of histologic lesions at the ileal margin, detected by histology, have been associated with increased rates of recurrence after ileocaecal surgery in patients with Crohn's disease (CD). We aimed to characterize histologic features of the ileal margin and to evaluate their association with disease recurrence.
We collected histologic data from 211 patients with ileal or ileocolonic CD who underwent ileocolonic resections at hospitals in France from September 2010 through December 2016. Ileal margins were analyzed. Early endoscopic recurrence was defined by a Rutgeerts score of i2 or more, 6 months after surgery. We also collected data from 10 adults with healthy ileum who underwent ileocecal resection for colonic tumors (controls). Clinical relapse was defined by CD-related symptoms confirmed by imaging, endoscopy, therapy intensification, CD-related complication, or subsequent surgery.
Six months after surgery, 49% of patients had endoscopic recurrence; 5 years after surgery, 57% of patients had clinical relapse. Ileal margins were macroscopically affected in 20.9% of patients. CD transmural lesions at the margin (defined by mucosal ulceration or cryptitis, submucosal fibrosis and lymphoplasmacytic infiltrate of the subserosa) were observed in 13.6% of patients. Endoscopic recurrence was observed in 75% of patients with CD transmural lesions vs 46% of patients without (P =.005). In multivariate analysis, CD transmural lesions at the margin were independently associated with early endoscopic recurrence (OR, 3.83; 95% CI, 1.47-11.05; P =.008) and clinical recurrence (OR 2.04; 95% CI, 1.09-3.99; P =.026).
In patients with CD, transmural lesions at the ileal margin were associated with an increased risk of post-operative recurrence. Histologic features of the ileal margin should be included in making decisions about post-operative therapy.
通过组织学检查发现，回肠边缘存在不同类型的组织学病变与克罗恩病（CD）患者回肠结肠手术后的复发率增加有关。我们旨在描述回肠边缘的组织学特征，并评估其与疾病复发的关系。
我们收集了 2010 年 9 月至 2016 年 12 月期间在法国医院接受回肠或回结肠切除术的 211 例回肠或回结肠 CD 患者的组织学数据。分析回肠边缘。手术后 6 个月时 Rutgeerts 评分 i2 或更高定义为早期内镜复发。我们还收集了 10 例因结肠肿瘤而接受回结肠切除术的健康回肠成年人（对照组）的数据。临床复发定义为通过影像学、内镜、治疗强化、CD 相关并发症或后续手术证实的 CD 相关症状。
手术后 6 个月，49%的患者出现内镜复发；手术后 5 年，57%的患者出现临床复发。20.9%的患者回肠边缘肉眼受累。13.6%的患者存在边缘的 CD 穿壁病变（定义为黏膜溃疡或隐窝炎、黏膜下纤维化和浆膜下淋巴浆细胞浸润）。在存在 CD 穿壁病变的患者中观察到 75%的患者出现内镜复发，而在无 CD 穿壁病变的患者中观察到 46%的患者出现内镜复发（P =.005）。在多变量分析中，边缘的 CD 穿壁病变与早期内镜复发（OR，3.83；95%CI，1.47-11.05；P =.008）和临床复发（OR，2.04；95%CI，1.09-3.99；P =.026）独立相关。
在 CD 患者中，回肠边缘的穿壁病变与术后复发风险增加相关。回肠边缘的组织学特征应纳入术后治疗决策中。
