溃疡性结肠炎的节段性结肠切除术：在无活动性结肠炎的选定患者中是否有一席之地？72 例患者的国际多中心回顾性研究。

Segmental Colectomy for Ulcerative Colitis: Is There a Place in Selected Patients Without Active Colitis? An International Multicentric Retrospective Study in 72 Patients.

机构信息

Department of Colorectal Surgery, Beaujon Hospital, Assistance Publique-Hôpitaux de Paris, Clichy and Université de Paris, France.

Department of Gastroenterology, Beaujon Hospital, Assistance Publique-Hôpitaux de Paris, Université Paris VII, Clichy, France.

出版信息

J Crohns Colitis. 2020 Dec 2;14(12):1687-1692. doi: 10.1093/ecco-jcc/jjaa107.

DOI:10.1093/ecco-jcc/jjaa107

PMID:32498084

Abstract

BACKGROUND AND AIMS

The aim of this study was to report a multicentric experience of segmental colectomy [SC] in ulcerative colitis [UC] patients without active colitis, in order to assess if SC can or cannot represent an alternative to ileal pouch-anal anastomosis [IPAA].

METHODS

All UC patients undergoing SC were included. Postoperative complications according to ClavienDindo's classification, long term results, and risk factors for postoperative colitis and reoperation for colitis on the remnant colon, were assessed.

RESULTS

A TOTAL OF: 72 UC patients underwent: sigmoidectomy [n = 28], right colectomy [n = 24], proctectomy [n = 11], or left colectomy [n = 9] for colonic cancer [n = 27], 'diverticulitis' [n = 17], colonic stenosis [n = 5], dysplasia or polyps [n = 8], and miscellaneous [n = 15]. Three patients died postoperatively and 5/69 patients [7%] developed early flare of UC within 3 months after SC. After a median followup of 40 months, 24/69 patients [35%] were reoperated after a median delay after SC of 19 months [range, 2-158 months]: 22/24 [92%] underwent total colectomy and ileorectal anastomosis [n = 9] or total coloproctectomy [TCP] [n = 13] and 2/24 [8%] an additional SC. Reasons for reoperation were: colitis [n = 14; 20%], cancer [n = 3] or dysplasia [n = 3], colonic stenosis [n = 1], and unknown reasons [n = 3]. Endoscopic score of colitis before SC was Mayo 23 in 5/5 [100%] patients with early flare vs 15/42 without early flare [36%; p = 0.0101] and in 9/12 [75%] patients with reoperation for colitis vs 11/35 without reoperation [31%; p = 0.016].

CONCLUSIONS

After segmental colectomy in UC patients, postoperative early colitis is rare [7%]. Segmental colectomy could possibly represent an alternative to IPAA in selected UC patients without active colitis.

摘要

背景与目的

本研究旨在报告溃疡性结肠炎（UC）患者无活动性结肠炎时行节段性结肠切除术（SC）的多中心经验，以评估 SC 是否可替代回肠储袋肛管吻合术（IPAA）。

方法

纳入所有接受 SC 的 UC 患者。评估术后并发症（根据 Clavien-Dindo 分级）、长期结果、术后结肠炎和回肠储袋肛管吻合术（IPAA）的危险因素。

结果

共 72 例 UC 患者行：乙状结肠切除术[n = 28]、右半结肠切除术[n = 24]、直肠切除术[n = 11]或左半结肠切除术[n = 9]治疗结直肠癌[n = 27]、“憩室炎”[n = 17]、结肠狭窄[n = 5]、异型增生或息肉[n = 8]和其他[n = 15]。3 例患者术后死亡，5/69 例（7%）患者在 SC 后 3 个月内出现 UC 早期发作。中位随访 40 个月后，24/69 例（35%）患者在 SC 后中位 19 个月后再次手术[范围，2-158 个月]：22/24 例（92%）患者行全结肠切除术和回直肠吻合术[n = 9]或全结肠直肠切除术[n = 13]和 2/24 例（8%）患者行额外的 SC。再次手术的原因是：结肠炎[n = 14；20%]、癌症[n = 3]或异型增生[n = 3]、结肠狭窄[n = 1]和未知原因[n = 3]。SC 前结肠炎内镜评分 Mayo 2-3 分的患者中有 5/5 例（100%）出现早期发作，而 Mayo 0-2 分的患者中有 15/42 例（36%）出现早期发作[p = 0.0101]；SC 后出现结肠炎的患者中有 9/12 例（75%），而无结肠炎的患者中有 11/35 例（31%）[p = 0.016]。