Landerholm K, Reali C, Mortensen N J, Travis S P L, Guy R J, George B D
Department of Colorectal Surgery, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.
Department of Surgery, Ryhov County Hospital, Jönköping and Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden.
Colorectal Dis. 2020 Sep;22(9):1159-1168. doi: 10.1111/codi.15013. Epub 2020 Mar 10.
To evaluate the frequency and outcome of strictureplasty in the era of biologicals and to compare patients operated on by strictureplasty alone, resection alone or a combination of both.
A retrospective review of all patients undergoing strictureplasty for obstructing jejunoileal Crohn's disease (CD) in Oxford between 2004 and 2016 was conducted. For comparison, a cohort of CD patients with resection only during 2009 and 2010 was included.
In all, 225 strictureplasties were performed during 85 operations, 37 of them in isolation and 48 with simultaneous resection. Another 82 procedures involved resection only; these patients had shorter disease duration, fewer previous operations and longer bowel preoperatively. The frequency of strictureplasty procedures did not alter during the study period and was similar to that in the preceding 25 years. There was no postoperative mortality. One patient required re-laparotomy for a leak after strictureplasty. None developed cancer. The 5-year reoperation rate for recurrent obstruction was 22% (95% CI 12-39) for resection alone, 30% (17-52) for strictureplasty alone and 42% (27-61) for strictureplasty and resection (log rank P = 0.038). Young age was a risk factor for surgical recurrence (log rank P = 0.006).
The use of strictureplasty in CD has not changed significantly since the widespread introduction of biologicals. Surgical morbidity remains low. The risk of recurrent strictures is high and young age is a risk factor. In this study, strictureplasty alone was associated with a lower rate of reoperation compared with strictureplasty with resection.
评估生物制剂时代狭窄成形术的频率及结果，并比较单纯接受狭窄成形术、单纯切除术或两者联合手术的患者情况。
对2004年至2016年在牛津因空回肠克罗恩病（CD）梗阻接受狭窄成形术的所有患者进行回顾性研究。为作比较，纳入了一组2009年至2010年期间仅接受切除术的CD患者。
总共在85例手术中进行了225次狭窄成形术，其中37例为单独进行，48例与同期切除术联合进行。另外82例手术仅涉及切除术；这些患者病程较短，既往手术次数较少，术前肠段较长。在研究期间，狭窄成形术的频率没有改变，与之前25年相似。无术后死亡病例。1例患者在狭窄成形术后因渗漏需要再次剖腹手术。无患者发生癌症。单纯切除术治疗复发性梗阻的5年再次手术率为22%（95%可信区间12 - 39），单纯狭窄成形术为30%（17 - 52），狭窄成形术与切除术联合为42%（27 - 61）（对数秩检验P = 0.038）。年轻是手术复发的危险因素（对数秩检验P = 0.006）。
自生物制剂广泛应用以来，CD患者中狭窄成形术的使用没有显著变化。手术并发症发生率仍然较低。复发性狭窄的风险较高，年轻是一个危险因素。在本研究中，与狭窄成形术联合切除术相比，单纯狭窄成形术的再次手术率较低。
