阳性切缘是克罗恩病回肠末端切除术后复发的一个危险因素。

Positive histologic margins is a risk factor of recurrence after ileocaecal resection in Crohn's disease.

机构信息

Gastroenterology, Amiens University and Hospital, Université de Picardie Jules Verne, Amiens, France.

Pathology Unit, Amiens University and Hospital, Université de Picardie Jules Verne, Amiens, France.

出版信息

Clin Res Hepatol Gastroenterol. 2021 Sep;45(5):101569. doi: 10.1016/j.clinre.2020.10.013. Epub 2020 Nov 14.

DOI:10.1016/j.clinre.2020.10.013

PMID:33199239

Abstract

INTRODUCTION

Surgical resection is not curative in Crohn's disease (CD) and, recurrence after surgery is a common situation. The identification of patients at high risk of recurrence remains disappointing in clinical practice.

OBJECTIVE

To evaluate the impact of residual microscopic disease on margins on the risk of recurrence after ileocaecal resection in CD.

PATIENTS AND METHODS

All patients who underwent ileocaecal resection between January 1992 and December 2016 were prospectively identified. Demographic data, clinical, surgical and histological variables were retrospectively collected. Positive histologic margin was assessed prospectively and defined by the presence of acute inflammatory lesions on margins: erosion, ulceration, chorion infiltration by neutrophils, cryptic abscesses or cryptitis.

RESULTS

One hundred twenty five patients were included, with a median follow-up of 8 years (Interquartile Range (IQR), 4.3-15.2). Half (49.6%, n = 62) were women, and the median age at surgery was 33 years (IQR, 24-42). Fifty-six (44.8%) had positive inflammatory margins. Five years after surgery, respectively 29 (51%) and 23 (34%) patients with positive and negative margins had clinical recurrence (p = 0.034). At the end of the follow-up, respectively 60% (n = 34) and 47% (n = 33) patients had clinical recurrence (p = 0.07). CD-related hospitalizations were observed in respectively 37.5% (n = 21) and 18.8% (n = 13) with positive and negative margins (p = 0.02). Fourteen patients (25%) with positive intestinal margins had surgical recurrence at the end of the follow-up compared to 5 patients (7%) with negative margins (p = 0.04). Multivariate analysis confirmed that positive intestinal margin was independently associated with surgical recurrence (OR, 4.7 (CI95%, 1.4-15.3), p = 0.01).

CONCLUSION

Positive histologic margin was associated with an increased risk of clinical and surgical recurrence after ileocaecal resection for Crohn's disease.

摘要

介绍

手术切除在克罗恩病（CD）中不能治愈，且术后复发是常见情况。在临床实践中，仍难以识别高复发风险的患者。

目的

评估回肠末端切除术时残留微观疾病对边缘的影响与 CD 术后复发的关系。

患者和方法

前瞻性地确定了 1992 年 1 月至 2016 年 12 月期间接受回肠末端切除术的所有患者。回顾性收集人口统计学数据、临床、手术和组织学变量。前瞻性评估阳性组织学边缘，定义为边缘存在急性炎症病变：侵蚀、溃疡、中性粒细胞浸润的绒毛、隐窝脓肿或隐窝炎。

结果

共纳入 125 例患者，中位随访时间为 8 年（四分位距（IQR），4.3-15.2）。女性占一半（49.6%，n=62），手术时的中位年龄为 33 岁（IQR，24-42）。56 例（44.8%）存在阳性炎症边缘。术后 5 年，分别有 29 例（51%）和 23 例（34%）阳性和阴性边缘的患者出现临床复发（p=0.034）。在随访结束时，分别有 60%（n=34）和 47%（n=33）的患者出现临床复发（p=0.07）。分别有 37.5%（n=21）和 18.8%（n=13）的阳性和阴性边缘患者出现与 CD 相关的住院治疗（p=0.02）。在随访结束时，14 例（25%）有阳性肠边缘的患者出现手术复发，而 5 例（7%）有阴性边缘的患者出现手术复发（p=0.04）。多变量分析证实，阳性肠边缘与回肠末端切除术治疗 CD 后的临床和手术复发独立相关（OR，4.7（95%CI，1.4-15.3），p=0.01）。