IBD Unit, Department of Medical and Surgical Science, Sant'Orsola-Malpighi Hospital -University of Bologna, via Massarenti 9, 40138 Bologna, Italy.
Division of Hepato-Gastroenterology, Department of Clinical and Experimental Medicine, Second University of Naples, Via Pansini 5, 80131 Naples, Italy.
Dig Liver Dis. 2021 May;53(5):592-597. doi: 10.1016/j.dld.2020.06.021. Epub 2020 Jun 29.
Crohn's disease represents a heterogeneous entity, but its location tends to be relatively stable overtime. For extensive refractory Crohn's colitis, ileorectal anastomosis after colectomy is an engaging option, since the necessity of a permanent ileostomy is avoided.
In our study, the long-term outcome of two groups of patients with Crohn's colitis who underwent colectomy and ileorectal anastomosis was compared. The first group had isolated colonic Crohn's disease without rectal involvement and perianal disease, while the second group included patients who had rectal and/or ileal involvement, with or without perianal disease.
Between 1996 and 2016, in a single IBD tertiary center, 80 patients with a history of colectomy and ileorectal anastomosis for refractory Crohn's colitis were retrospectively identified.
Recurrence of disease was diagnosed in 57/64 of patients with Crohn's colitis with rectal and/or ileal and/or perianal involvement compared with 1/16 of patients with isolated Crohn's colitis without rectal and perianal disease in a median time of recurrence of 2 years (IQR 1-6 years, minimum to maximum, 1-18 years, p < 0.001). Only 6 patients (7,5%) underwent definitive end ileostomy without proctectomy (1 in the noIRP group and 5 in the IRP group).
Our data suggest that colectomy with ileorectal anastomosis may represent a curative option in patients with refractory isolated colitis without rectal and perianal involvement.
克罗恩病是一种异质性疾病，但它的位置往往随着时间的推移相对稳定。对于广泛难治性克罗恩病结肠炎，结肠切除后回肠直肠吻合术是一种有吸引力的选择，因为避免了永久性回肠造口术的需要。
本研究比较了两组接受结肠切除和回肠直肠吻合术的克罗恩病结肠炎患者的长期结果。第一组患者为无直肠受累和肛周疾病的孤立性结肠克罗恩病，而第二组患者包括有直肠和/或回肠受累，伴有或不伴有肛周疾病的患者。
在 1996 年至 2016 年间，在一个单一的 IBD 三级中心，回顾性地确定了 80 例因难治性克罗恩病结肠炎而行结肠切除和回肠直肠吻合术的患者。
在有直肠和/或回肠和/或肛周疾病受累的克罗恩病结肠炎患者中，57/64 例（89%）诊断为疾病复发，而在无直肠和肛周疾病受累的孤立性克罗恩病结肠炎患者中，1/16 例（6%）诊断为疾病复发，中位复发时间为 2 年（IQR 1-6 年，最短至最长 1-18 年，p<0.001）。只有 6 例患者（7.5%）接受了确定性末端回肠造口术而无需直肠切除术（无 IRP 组 1 例，IRP 组 5 例）。
我们的数据表明，对于无直肠和肛周受累的难治性孤立性结肠炎患者，结肠切除和回肠直肠吻合术可能是一种治愈性选择。
