Surgery of the Alimentary Tract, Department of Medical and Surgical Sciences, Sant'Orsola Hospital, Alma Mater Studiorum University of Bologna, Via Massarenti 9, 40138, Bologna, Italy.
Department of Specialist, Diagnostic and Experimental Medicine, Sant'Orsola Hospital, Alma Mater Studiorum University of Bologna, Bologna, Italy.
Tech Coloproctol. 2020 Jul;24(7):711-720. doi: 10.1007/s10151-020-02208-7. Epub 2020 Apr 18.
The number of indications for strictureplasty for Crohn's disease has been greatly reduced since the widespread use of biologics, although the risk of intestinal failure remains. The aim of the study was to analyze the outcomes of strictureplasty and to identify risk factors for site-specific recurrence in the era of biologics.
Consecutive patients treated with strictureplasty for Crohn's disease between 2002 and 2018 were retrospectively included. Univariate analysis was carried out. Risk factors for recurrence were identified through a multilevel logistic regression analysis.
Two hundred sixty-six patients were included in the study ( 171 males, median age 39.5 years, range 18-76 years). The majority of the 718 strictures requiring surgery in these patients were located in the ileum (61%), treated with conventional strictureplasty (89.6%) and required an additional resection (73.7%). Median follow-up time and time to recurrence were 96 months and 62.5 months respectively. The site-specific recurrence rate was 12.2% at 5 years and 25.7% at 10 years. Smoking was associated with a higher risk of recurrence in patients with milder disease. The 10-year recurrence rate was significantly higher for strictureplasties performed in the terminal ileum (30.9%, p = 0.0019) as compared to the ileum (21.8%) and the jejunum (8.4%). Multilevel logistic regression analysis showed that postoperative exposure to biologics (OR 4.74, p 0.001), nonconventional strictureplasty (OR 3.57, p 0.008) and a strictureplasty performed on a previous anastomosis (OR 13.58, p 0.002) were associated with site-specific recurrence.
Strictureplasty is associated with optimal long-term outcomes in the biologic era and should be performed when feasible, to reduce the risk of intestinal failure in Crohn's disease patients.
自生物制剂广泛应用以来，克罗恩病狭窄成形术的适应证数量大大减少，尽管肠衰竭的风险仍然存在。本研究旨在分析狭窄成形术的结果，并确定生物制剂时代特定部位复发的危险因素。
回顾性纳入 2002 年至 2018 年间接受狭窄成形术治疗的克罗恩病连续患者。进行单变量分析。通过多级逻辑回归分析确定复发的危险因素。
本研究共纳入 266 例患者（171 例男性，中位年龄 39.5 岁，范围 18-76 岁）。这些患者中需要手术的 718 处狭窄中有 61%位于回肠，采用传统狭窄成形术（89.6%），73.7%需要再次切除。中位随访时间和复发时间分别为 96 个月和 62.5 个月。5 年和 10 年时的特定部位复发率分别为 12.2%和 25.7%。疾病较轻的患者中，吸烟与更高的复发风险相关。与回肠（21.8%）和空肠（8.4%）相比，回肠末端狭窄成形术（30.9%，p=0.0019）的 10 年复发率显著更高。多级逻辑回归分析显示，术后暴露于生物制剂（OR 4.74，p<0.001）、非传统狭窄成形术（OR 3.57，p<0.008）和先前吻合口狭窄成形术（OR 13.58，p<0.002）与特定部位复发相关。
在生物制剂时代，狭窄成形术与最佳的长期结果相关，应在可行时进行，以降低克罗恩病患者肠衰竭的风险。
