成功非手术治疗合并回肠结肠克罗恩病的腹腔脓肿后择期手术结局再评估：一项全国前瞻性队列的亚组分析。
A Reappraisal of Outcome of Elective Surgery After Successful Non-Operative Management of an Intra-Abdominal Abscess Complicating Ileocolonic Crohn's Disease: A Subgroup Analysis of a Nationwide Prospective Cohort.
机构信息
Digestive Surgery Department, Bicêtre Hospital, APHP, Paris-Sud University, Le Kremlin-Bicetre, France.
Department of Colorectal Surgery, Beaujon Hospital, APHP, Paris VII University, Clichy, France.
出版信息
J Crohns Colitis. 2021 Mar 5;15(3):409-418. doi: 10.1093/ecco-jcc/jjaa217.
BACKGROUND AND AIMS
Few prospective data exist on outcomes of surgery in Crohn's disease [CD] complicated by an intra-abdominal abscess after resolution of this abscess by antibiotics optionally combined with drainage.
METHODS
From 2013 to 2015, all patients undergoing elective surgery for CD after successful non-operative management of an intra-abdominal abscess [Abscess-CD group] were selected from a nationwide multicentre prospective cohort. Resolution of the abscess had to be computed tomography/magnetic resonance-proven prior to surgery. Abscess-CD group patients were 1:1 matched to uncomplicated CD [Non-Penetrating-CD group] using a propensity score. Postoperative results and long-term outcomes were compared between the two groups.
RESULTS
Among 592 patients included in the registry, 63 [11%] fulfilled the inclusion criteria. The abscess measured 37 ± 20 mm and was primarily managed with antibiotics combined with drainage in 14 patients and nutritional support in 45 patients. At surgery, a residual fluid collection was found in 16 patients [25%]. Systemic steroids within 3 months before surgery [p = 0.013] and the absence of preoperative enteral support [p = 0.001] were identified as the two significant risk factors for the persistence of a fluid collection. After propensity score matching, there was no significant difference between the Abscess-CD and Non-Penetrating-CD groups in the rates of primary anastomosis [84% vs 90% respectively, p = 0.283], overall [28% vs 15% respectively, p = 0.077] and severe postoperative morbidity [7% vs 7% respectively, p = 1.000]. One-year recurrence rates for endoscopic recurrence were 41% in the Abscess-CD and 51% in the Non-Penetrating-CD group [p = 0.159].
CONCLUSIONS
Surgery after successful non-operative management of intra-abdominal abscess complicating CD provides good early and long-term outcomes.
背景与目的
抗生素联合引流选择性治疗腹腔脓肿后缓解克罗恩病（CD）合并腹腔脓肿的手术结局，目前仅有少量前瞻性数据。
方法
2013 年至 2015 年，从全国多中心前瞻性队列中选择所有成功接受非手术治疗后行择期手术治疗的 CD 合并腹腔脓肿（脓肿-CD 组）患者。手术前必须通过计算机断层扫描/磁共振成像证实脓肿已经消退。脓肿-CD 组患者采用倾向评分与无穿透性 CD（非穿透-CD 组）患者进行 1:1 匹配。比较两组患者的术后结果和长期结局。
结果
在登记的 592 例患者中，有 63 例（11%）符合纳入标准。脓肿直径为 37±20mm，14 例患者主要接受抗生素联合引流治疗，45 例患者接受营养支持治疗。手术时，16 例患者（25%）发现残余液体积聚。术前 3 个月内使用全身类固醇[P=0.013]和缺乏术前肠内支持[P=0.001]被确定为液体积聚持续存在的两个显著危险因素。在倾向评分匹配后，脓肿-CD 组和非穿透-CD 组的主要吻合口吻合率[分别为 84%和 90%，P=0.283]、总吻合率[分别为 28%和 15%，P=0.077]和严重术后发病率[分别为 7%和 7%，P=1.000]无显著差异。脓肿-CD 组和非穿透-CD 组内镜复发的 1 年复发率分别为 41%和 51%[P=0.159]。
结论
成功非手术治疗 CD 合并腹腔脓肿后行手术治疗可获得良好的早期和长期结局。
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