Division of General and HPB Surgery, ASST Rhodense - Rho, Corso Europa, 250, 20017 - Rho, Milan, Italy.
Division of General Surgery, ASST Fatebenefratelli - Sacco, Milan, Italy.
Dig Liver Dis. 2021 Oct;53(10):1286-1293. doi: 10.1016/j.dld.2021.01.023. Epub 2021 Feb 21.
Laparoscopy is considered the best surgical approach for Crohn's Disease (CD), and strictureplasty a reliable alternative to intestinal resection. Nevertheless, their association has never been evaluated.
To investigate feasibility and safety of conventional (SP) and non-conventional (NCSP) strictureplasties, using laparoscopy, for complicated CD.
Starting January 2008, a prospective cohort study was performed, in consecutive, unselected patients, undergoing primary surgery for CD (Group-A). The residential database (CD-CARD) was used for the retrospective extraction of control patients (Group-B). Univariate and multi-variate analysis of pre-operative characteristics, intra-operative findings, morbidity, and intra-abdominal septic complications (IASCs) was performed.
Between January 2008 and December 2019, 331 patients received 162 SPs, 138 NCSPs, and 373 resections (Group-A). From the CD-CARD, 227 control patients received 159 SPs, 117 NCSPs, and 271 resections (Group-B) (ns). Preoperatively, Group-A presented batter nutritional status and received more biological therapies, Group-B more steroids. Group-A presented less abdominal abscesses, planned ostomies, minor complications, shorter operating time and hospitalization than Group-B, but similar major complications, IASCs and anastomotic leaks. IASCs were related to older age, elevated inflammatory indices, and preoperative treatment with high-risk drugs.
SP and NCSP are feasible by laparoscopy, with low morbidity rate, confirming the advantages of both minimally invasive and conservative surgery.
腹腔镜检查被认为是克罗恩病（CD）的最佳手术方法，而狭窄成形术是肠切除术的可靠替代方法。然而，它们的联合应用从未被评估过。
探讨腹腔镜下常规（SP）和非常规（NCSP）狭窄成形术治疗复杂 CD 的可行性和安全性。
自 2008 年 1 月起，对连续、未经选择的 CD 患者进行前瞻性队列研究（A 组），对原发性手术患者进行研究。使用 CD-CARD 回顾性提取对照患者（B 组）。对术前特征、术中发现、发病率和腹腔内感染性并发症（IASCs）进行单因素和多因素分析。
2008 年 1 月至 2019 年 12 月，331 例患者接受了 162 例 SP、138 例 NCSP 和 373 例切除术（A 组）。从 CD-CARD 中，227 例对照患者接受了 159 例 SP、117 例 NCSP 和 271 例切除术（B 组）（无统计学差异）。A 组术前营养状况较好，接受生物治疗较多，B 组术前使用激素较多。A 组与 B 组相比，腹部脓肿、计划造口术、小并发症、手术时间和住院时间较短，但主要并发症、IASCs 和吻合口漏的发生率相似。IASCs 与年龄较大、炎症指标升高以及术前使用高危药物有关。
腹腔镜下 SP 和 NCSP 是可行的，具有较低的发病率，证实了微创和保守手术的优势。
