Duan Yantao, Liu Yifan, Li Yousheng
Department of General Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Gastroenterol Res Pract. 2020 Sep 15;2020:2194382. doi: 10.1155/2020/2194382. eCollection 2020.
To assess the influence of a previous intestinal resection on postoperative complications for Crohn's disease (CD).
Data on patients with CD undergoing surgery in our department from January 2016 through December 2019 were retrospectively reviewed. Information collected included demographic details, surgical data, and postoperative outcome. A cross-sectional study design was employed. Associations between postoperative complications and preoperative clinical indicators were further analyzed.
Of the 129 patients with CD studied, 62 patients (48.06%) underwent previous resection. These patients were more likely to be older ( = 0.031), have longer disease duration ( = 0.025), use less 5-aminosalicylic acid/sulfasalazine preoperatively ( = 0.013), have lower body mass index ( = 0.003), and have a higher American Society of Anesthesiologists (ASA) Physical Status Classification System score ( = 0.043). Patients who had previous surgery had a longer duration of operation ( = 0.003), greater estimated blood loss ( = 0.001), and longer hospital stay ( < 0.001) and were more inclined to develop postoperative complications ( = 0.047), particularly anastomotic leak ( = 0.021) and severe (Clavien-Dindo grade III/IV) complications ( = 0.038). After multivariate analysis, previous intestinal resection ( = 0.019), preoperative use of steroids ( = 0.026), and ASA score of more than II ( < 0.001) were determined to be the independent prognostic risk factors for postoperative complications. During the 30-day follow-up period, there was no postoperative mortality or readmission.
Previous intestinal resection in patients with CD is an independent predictor of overall postoperative complications.
评估既往肠道切除术对克罗恩病（CD）术后并发症的影响。
回顾性分析2016年1月至2019年12月在我科接受手术的CD患者的数据。收集的信息包括人口统计学细节、手术数据和术后结果。采用横断面研究设计。进一步分析术后并发症与术前临床指标之间的关联。
在研究的129例CD患者中，62例（48.06%）曾接受过切除术。这些患者年龄较大（P = 0.031）、病程较长（P = 0.025）、术前使用5-氨基水杨酸/柳氮磺胺吡啶较少（P = 0.013）、体重指数较低（P = 0.003）、美国麻醉医师协会（ASA）身体状况分类系统评分较高（P = 0.043）。曾接受手术的患者手术时间较长（P = 0.003）、估计失血量较大（P = 0.001）、住院时间较长（P < 0.001），且更倾向于发生术后并发症（P = 0.047），尤其是吻合口漏（P = 0.021）和严重（Clavien-Dindo III/IV级）并发症（P = 0.038）。多因素分析后，既往肠道切除术（P = 0.019）、术前使用类固醇（P = 0.026）和ASA评分大于II（P < 0.001）被确定为术后并发症的独立预后危险因素。在30天的随访期内，无术后死亡或再入院情况。
CD患者既往肠道切除术是术后总体并发症的独立预测因素。
