Division of Gastroenterology and Hepatology, Department of Medicine.
Multidisciplinary Center for Inflammatory Bowel Diseases.
Curr Opin Gastroenterol. 2020 Jul;36(4):277-283. doi: 10.1097/MOG.0000000000000638.
Despite multiple advances in the medical treatment of Crohn's disease, it is recognized that a significant proportion of patients will ultimately require surgical resection at some point during their disease course. This review focuses on the postoperative management of patients with Crohn's disease, with the goal of preventing endoscopic and clinical recurrence, and future surgery.
Surgery is an integral part of the multidisciplinary approach to the management of patients with Crohn's disease. Recent literature and guidelines have focused on a standardized and evidence-based approach to the management of patients in the postoperative setting. This approach should utilize risk stratification at the time of surgery, initiation of appropriate therapy among high-risk patients, and objective evaluation in the postoperative period, including ileocolonoscopy at 6-12 months after a surgical resection.
A standardized approach to the postoperative management of patients with Crohn's disease is critical. Identifying those patients at high-risk for endoscopic and clinical recurrence is essential, as these patients will likely require early medical therapy. While novel objective assessments are emerging, all patients should undergo ileocolonoscopy at 6-12 months and further decision making should be based on the presence of endoscopic recurrence.
尽管在克罗恩病的医学治疗方面取得了多项进展，但人们认识到，在疾病过程中的某个阶段，相当一部分患者最终将需要手术切除。本综述重点介绍克罗恩病患者的术后管理，旨在预防内镜和临床复发以及未来的手术。
手术是克罗恩病患者多学科治疗方法的一个组成部分。最近的文献和指南侧重于对术后患者进行标准化和基于证据的管理方法。这种方法应在手术时进行风险分层，在高危患者中开始适当的治疗，并在术后进行客观评估，包括在手术切除后 6-12 个月进行回结肠镜检查。
对克罗恩病患者进行标准化的术后管理至关重要。确定那些内镜和临床复发风险高的患者至关重要，因为这些患者可能需要早期药物治疗。虽然新的客观评估方法正在出现，但所有患者均应在 6-12 个月时进行回结肠镜检查，进一步的决策应基于内镜复发的情况。
