Gastrointestinal Surgery Unit, Tor Vergata University Hospital, Viale Oxford 81, 00133, Rome, Italy.
Department of Surgery, "Vito Fazzi" Hospital, Piazza F. Muratore, 73100, Lecce, Italy.
Updates Surg. 2020 Sep;72(3):773-780. doi: 10.1007/s13304-020-00738-1. Epub 2020 Mar 17.
Active Crohn's disease has a substantial impact on Quality of Life (QoL). Medical management could be associated to side effects, hospitalization, long treatment period and requires patient's compliance, impacting QoL. Ileocecal resection (ICR) is often required, open or laparoscopic. Aim of the study was to assess Health-Related (HR) QoL changes following ICR, and to identify factors impacting on QoL in the short and mid-term. From a single institution, we created a prospective database of patients undergoing ICR from 01/2009 to 12/2015. HRQoL was analysed with Cleveland Global Quality of Life (CGQL) score, Overall Quality of Happiness (OQH), and asking patients if they would have surgery again. QoL scores were recorded at 30 days, 6, 12 and 36 months postoperatively and compared according to follow-up timing, technique, medical treatment and demographics. Statistical analysis included 187 patients. Mean follow-up was 3.8 ± 2.9 years. Both at 30 days and 6 months postoperatively, CGQL, its items and OQH increased significantly (p < 0.001). Increased values were also recorded at 1 and 3 years; 88% of patients would undergo surgery again. Laparoscopy was associated with improved CGQL scores, while preoperative steroids with worsen data. Young female patients, with penetrating pattern, experienced greater HRQoL improvements. Surgery is associated with improvements of HRQoL and patients' happiness in the short and mid-term. Laparoscopy, steroid-free and young patients showed the best results. ICR should be considered a reasonable alternative to non-operative strategies in selected cases.
活动性克罗恩病对生活质量（QoL）有重大影响。医学治疗可能会带来副作用、住院、治疗周期长且需要患者配合，从而影响生活质量。通常需要进行回肠末端切除术（ICR），可采用开腹或腹腔镜。本研究的目的是评估 ICR 后与健康相关的（HR）生活质量变化，并确定短期和中期影响生活质量的因素。我们从单一机构创建了一个从 2009 年 1 月至 2015 年 12 月接受 ICR 的患者的前瞻性数据库。使用克利夫兰全球生活质量（CGQL）评分、总体幸福感（OQH）分析 HRQoL，并询问患者是否会再次接受手术。术后 30 天、6、12 和 36 个月记录 QoL 评分，并根据随访时间、技术、药物治疗和人口统计学进行比较。统计分析包括 187 例患者。平均随访时间为 3.8±2.9 年。术后 30 天和 6 个月时，CGQL、其项目和 OQH 均显著增加（p<0.001）。1 年和 3 年时也记录到了更高的值；88%的患者会再次接受手术。腹腔镜与 CGQL 评分的改善相关，而术前使用类固醇则会使数据恶化。穿透性病变的年轻女性患者经历了更大的 HRQoL 改善。手术在短期和中期与 HRQoL 和患者幸福感的改善相关。腹腔镜、无类固醇和年轻患者的结果最好。在选定的病例中，ICR 应被视为非手术策略的合理替代方案。
