回肠末端标本的显微镜下炎症与克罗恩病回肠末端切除术后吻合口漏发生率的增加无关。
Microscopic inflammation in ileocecal specimen does not correspond to a higher anastomotic leakage rate after ileocecal resection in Crohn's disease.
机构信息
Department of Surgery, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.
Department of Pathology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.
出版信息
PLoS One. 2021 Mar 4;16(3):e0247796. doi: 10.1371/journal.pone.0247796. eCollection 2021.
BACKGROUND
Patients with Crohn's disease suffer from a higher rate of anastomotic leakages after ileocecal resection than patients without Crohn's disease. Our hypothesis was that microscopic inflammation at the resection margins of ileocecal resections in Crohn's disease increases the rate of anastomotic leakages.
PATIENTS AND METHODS
In a retrospective cohort study, 130 patients with Crohn's disease that underwent ileocecal resection between 2015 and 2019, were analyzed. Anastomotic leakage was the primary outcome parameter. Inflammation at the resection margin was characterized as "inflammation at proximal resection margin", "inflammation at distal resection margin" or "inflammation at both ends".
RESULTS
46 patients (35.4%) showed microscopic inflammation at the resection margins. 17 patients (13.1%) developed anastomotic leakage. No difference in the rate of anastomotic leakages was found for proximally affected resection margins (no anastomotic leakage vs. anastomotic leakage: 20.3 vs. 35.3%, p = 0.17), distally affected resection margins (2.7 vs. 5.9%, p = 0.47) or inflammation at both ends (9.7 vs. 11.8%, p = 0.80). No effect on the anastomotic leakage rate was found for preoperative hemoglobin concentration (no anastomotic leakage vs. anastomotic leakage: 12.3 vs. 13.5 g/dl, p = 0.26), perioperative immunosuppressive medication (62.8 vs. 52.9%, p = 0.30), BMI (21.8 vs. 22.4 m2/kg, p = 0.82), emergency operation (21.2 vs. 11.8%, p = 0.29), laparoscopic vs. open procedure (p = 0.58), diverting ileostomy (31.9 vs. 57.1%, p = 0.35) or the level of surgical training (staff surgeon: 80.5 vs. 76.5%, p = 0.45).
CONCLUSION
Microscopic inflammation at the resection margins after ileocecal resection in Crohn's disease is common. Histologically inflamed resection margins do not appear to affect the rate of anastomotic leakages. Our data suggest that there is no need for extensive resections or frozen section to achieve microscopically inflammation-free resection margins.
背景
与无克罗恩病的患者相比，克罗恩病患者行回盲部切除术后吻合口漏的发生率更高。我们的假设是，克罗恩病回盲部切除术后吻合口边缘的微观炎症会增加吻合口漏的发生率。
方法
在一项回顾性队列研究中，分析了 2015 年至 2019 年间 130 例克罗恩病患者行回盲部切除术的临床资料。吻合口漏是主要的观察终点。将吻合口边缘的炎症分为“近端吻合口边缘炎症”、“远端吻合口边缘炎症”或“两端均有炎症”。
结果
46 例（35.4%）患者的吻合口边缘存在显微镜下炎症。17 例（13.1%）患者发生吻合口漏。近端吻合口边缘受累（无吻合口漏 vs. 吻合口漏：20.3% vs. 35.3%，p=0.17）、远端吻合口边缘受累（2.7% vs. 5.9%，p=0.47）或两端均有炎症（9.7% vs. 11.8%，p=0.80）的患者，其吻合口漏的发生率均无差异。术前血红蛋白浓度（无吻合口漏 vs. 吻合口漏：12.3 vs. 13.5 g/dl，p=0.26）、围手术期免疫抑制药物（62.8% vs. 52.9%，p=0.30）、BMI（21.8 vs. 22.4 m2/kg，p=0.82）、急诊手术（21.2% vs. 11.8%，p=0.29）、腹腔镜与开放手术（p=0.58）、预防性回肠造口术（31.9% vs. 57.1%，p=0.35）或手术医生经验水平（主治医生：80.5% vs. 76.5%，p=0.45）对吻合口漏的发生率均无影响。
结论
克罗恩病患者回盲部切除术后吻合口边缘存在显微镜下炎症较为常见。组织学上有炎症的吻合口边缘似乎不会影响吻合口漏的发生率。我们的数据表明，无需进行广泛的切除术或冰冻切片检查，以获得显微镜下无炎症的吻合口边缘。
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