Department of Gastroenterology, Sandwell and West Birmingham Hospitals NHS Trust, West Bromwich, UK.
Institute of Applied Health Research, University of Birmingham, Birmingham, UK.
Aliment Pharmacol Ther. 2021 Jan;53(1):114-127. doi: 10.1111/apt.16114. Epub 2020 Oct 21.
Crohn's disease (CD) has a high-risk of bowel resection and later surgery for recurrent disease. Recent guidelines recommend colonoscopy 6-12 months following surgery to reduce further surgical intervention through medical therapy intensification.
To investigate the risk of further surgery at the anastomosis following right hemicolectomy for CD.
Hospital Episode Statistics were used to identify patients with CD and a right hemicolectomy between 2007 and 2016. Adherence to post-resection colonoscopy guidance timing and risk of further surgery at the anastomosis were examined. Cox proportional hazards models assessed risk factors for further surgery.
12 230 patients were identified: 45% male; median age 36 (IQR 26-49) years. Median follow-up was 5.9 (IQR 3.6-8.6) years: totalling 74 960 person-years. Median time to further surgery was 2.9 (IQR 1.2-5.3) years. By 5 years 9% and by 10 years 16.9% of those with sufficient follow-up had at least one further surgery involving the anastomotic site. Older, less deprived patients and those whose index surgery took place on an elective admission had a reduced risk of further surgery. The annual number of right hemicolectomies increased over the study from 1063 to 1317, driven by the increasing prevalence of CD. Overall, 78% of patients did not have a colonoscopy, as recommended, within 6-12 months following index resection.
Further surgery involving the anastomotic site remains common following index right hemicolectomy for CD. Post-surgical colonoscopy was only undertaken in 22% of patients within suggested timeframes. Increased colonoscopy may lead to a reduced need for surgery if early optimisation of medical therapy is undertaken for recurrence.
克罗恩病（CD）有很高的肠切除风险，且术后疾病复发需要再次手术。最近的指南建议在术后 6-12 个月行结肠镜检查，以通过强化药物治疗减少进一步手术干预。
研究 CD 行右半结肠切除术后吻合口再手术的风险。
利用医院住院统计数据，确定 2007 年至 2016 年间 CD 患者行右半结肠切除术的病例。观察吻合口再手术的术后结肠镜检查指导时间依从性和吻合口再手术风险。采用 Cox 比例风险模型评估再手术的风险因素。
共纳入 12230 例患者，其中男性占 45%，中位年龄 36（26-49）岁。中位随访时间为 5.9（3.6-8.6）年，共随访 74960 人年。中位再手术时间为 2.9（1.2-5.3）年。5 年内有 9%和 10 年内有 16.9%的患者有至少一次吻合口部位的再手术。年龄较大、社会经济地位较低的患者以及择期手术的患者，其再手术风险较低。研究期间，右半结肠切除术的年手术量从 1063 例增加到 1317 例，这主要是由于 CD 的患病率增加。总体而言，78%的患者未按照建议在指数切除术后 6-12 个月内进行结肠镜检查。
CD 行右半结肠切除术的患者吻合口再手术仍然很常见。只有 22%的患者在建议的时间范围内进行了术后结肠镜检查。如果对复发患者进行早期药物治疗优化，增加结肠镜检查可能会减少手术需求。
