Chen Ze-Xian, Chen Yong-Le, Huang Xiao-Ming, Lin Xu-Tao, He Xiao-Wen, Lan Ping
Department of Colorectal Surgery, the Sixth Affiliated Hospital, Sun Yat-Sen University, Guangzhou 510655, Guangdong Province, China.
Department of Hepatobiliary Surgery, the Sixth Affiliated Hospital, Sun Yat-Sen University, Guangzhou 510655, Guangdong Province, China.
World J Gastrointest Pharmacol Ther. 2019 Oct 15;10(4):67-74. doi: 10.4292/wjgpt.v10.i4.67.
Complications of Crohn's disease such as intestinal obstruction, fistula or perforation often need surgical treatment. Nearly 70%-80% patients with Crohn's disease would receive surgical treatment during the lifetime. However, surgical treatment is incurable for Crohn's disease. The challenge of recurrence postoperatively troubles both doctors and patients. Over 50% patients would suffer recurrence postoperatively. Some certain risk factors are associated with recurrence of Crohn's disease.
To evaluate the risk factors for endoscopic recurrence and clinical recurrence after bowel resection in Crohn's disease.
Patients diagnosed Crohn's disease and received intestinal resection between April 2007 and December 2013 were included in this study. Data on the general demographic information, preoperative clinical characteristics, surgical information, postoperative clinical characteristics were collected. Continuous data are expressed as median (inter quartile range), and categorical data as frequencies and percentages. Kaplan-Meier method was applied to estimate the impact of the clinical variables above on the cumulative rate of postoperative endoscopic recurrence and clinical recurrence, then log-rank test was applied to test the homogeneity of those clinical variables. Multivariate Cox proportional hazard regression analysis was performed to identify the risk factors of postoperative endoscopic recurrence and clinical recurrence.
A total of 64 patients were included in this study. The median follow-up time for the patients was 17 (9.25-25.75) mo. In this period, 41 patients (64.1%) had endoscopic recurrence or clinical recurrence. Endoscopic recurrence occurred in 34 (59.6%) patients while clinical recurrence occurred in 28 (43.8%) patients, with the interval between the operation and recurrence of 13.0 (8.0-24.5) months and 17.0 (8.0-27.8) mo, respectively. In univariate analysis, diagnosis at younger age ( < 0.001), disease behavior of penetrating ( = 0.044) and preoperative use of anti-tumor necrosis factor (TNF) ( = 0.020) were significantly correlated with endoscopic recurrence, while complication with perianal lesions ( = 0.032) and preoperative use of immunomodulatory ( = 0.031) were significantly correlated with clinical recurrence. As to multivariate analysis, diagnostic age ( = 0.004), disease behavior ( = 0.041) and preoperative use of anti-TNF ( = 0.010) were independent prognostic factors for endoscopic recurrence, while complication with perianal lesions ( = 0.023) was an independent prognostic factor for clinical recurrence.
Diagnostic age, disease behavior, preoperative use of anti-TNF and complication with perianal lesions were independent risk factors for postoperative recurrence in Crohn's disease.
克罗恩病的并发症如肠梗阻、瘘管或穿孔常需手术治疗。近70%-80%的克罗恩病患者在其一生中会接受手术治疗。然而，手术治疗无法治愈克罗恩病。术后复发的难题困扰着医生和患者双方。超过50%的患者术后会复发。某些特定的风险因素与克罗恩病的复发相关。
评估克罗恩病肠切除术后内镜复发和临床复发的风险因素。
本研究纳入了2007年4月至2013年12月期间诊断为克罗恩病并接受肠切除的患者。收集了一般人口统计学信息、术前临床特征、手术信息、术后临床特征的数据。连续数据以中位数（四分位间距）表示，分类数据以频率和百分比表示。采用Kaplan-Meier法评估上述临床变量对术后内镜复发和临床复发累积率的影响，然后应用对数秩检验来检验这些临床变量的同质性。进行多变量Cox比例风险回归分析以确定术后内镜复发和临床复发的风险因素。
本研究共纳入64例患者。患者的中位随访时间为17（9.25 - 25.75）个月。在此期间，41例患者（64.1%）发生了内镜复发或临床复发。34例（59.6%）患者发生了内镜复发，28例（43.8%）患者发生了临床复发，手术与复发的间隔分别为13.0（8.0 - 24.5）个月和17.0（8.0 - 27.8）个月。单因素分析中，诊断时年龄较小（<0.001）、穿透性疾病行为（=0.044）和术前使用抗肿瘤坏死因子（TNF）（=0.020）与内镜复发显著相关，而肛周病变并发症（=0.032）和术前使用免疫调节剂（=0.031）与临床复发显著相关。多因素分析中，诊断年龄（=0.004）、疾病行为（=0.041）和术前使用抗TNF（=0.010）是内镜复发的独立预后因素，而肛周病变并发症（=0.023）是临床复发的独立预后因素。
诊断年龄、疾病行为、术前使用抗TNF和肛周病变并发症是克罗恩病术后复发的独立风险因素。
