Department of Gastroenterological Surgery, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo, 663-8501, Japan.
Division of Infection Control and Prevention, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo, 663-8501, Japan.
BMC Surg. 2021 Mar 20;21(1):145. doi: 10.1186/s12893-020-00980-9.
Crohn's disease (CD) recurrence can occur not only at the site of anastomosis but also elsewhere in the bowel following an ileocolic resection (ICR) procedure. The aims of the present study were to assess long-term outcomes of a primary ICR procedure for CD in consecutive patients and examine the location of the reoperation causative lesion.
We examined cases of surgery with ICR initially performed at our institution. Those with simultaneous multiple bowel resection or bowel resection with strictureplasty were excluded.
A total of 169 patients who underwent ICR due to CD were enrolled. The median follow-up period was 12.6 years (range 4-27 years). A reoperation was needed in 45 (26.6%), of whom 14 had lesions causative of the reoperation at other than the anastomotic site. The most common causative lesion location was in the colon rather than the oral side of the small intestine. Furthermore, we investigated the relationship between presence of residual lesions following the initial surgery and lesions causative of reoperation. In the group without residual disease (n = 31), 29.0% (n = 9) had non-anastomotic lesions involved in indications for reoperation, while that was 35.7% (n = 5) in the group with residual disease (n = 14).
Anastomotic site lesion is not the only causative factor for reoperation following ICR. Regular examinations and applicable treatment with awareness that the cause of reoperation is not limited to the site of anastomosis are important in these cases.
克罗恩病（CD）复发不仅可能发生在肠吻合口部位，也可能发生在回肠结肠切除术（ICR）后肠的其他部位。本研究旨在评估连续患者接受初次 ICR 手术治疗 CD 的长期结果，并检查再手术的病变部位。
我们检查了在我院首次进行 ICR 手术的病例。排除同时进行多处肠切除或肠切除伴狭窄成形术的病例。
共纳入 169 例因 CD 而行 ICR 的患者。中位随访时间为 12.6 年（4-27 年）。45 例（26.6%）需要再次手术，其中 14 例的再手术病变部位不在吻合口处。最常见的病变部位是结肠而不是小肠的口侧。此外，我们还研究了初次手术后残留病变与再手术病变之间的关系。在无残留病变组（n=31）中，29.0%（n=9）的再手术适应证为非吻合口病变，而在有残留病变组（n=14）中，这一比例为 35.7%（n=5）。
吻合口部位病变不是 ICR 后再手术的唯一原因。对于这些患者，定期检查并在认识到再手术的原因不限于吻合口部位的情况下进行适当治疗很重要。
