Department of General Surgery, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China.
Department of General Surgery, Jinling Hospital, School of Medicine, Nanjing University, Nanjing, China.
J Invest Surg. 2022 Jun;35(6):1357-1365. doi: 10.1080/08941939.2021.2023713. Epub 2022 Jan 4.
Massive or repeated intestinal resections for Crohn's disease (CD) could lead to disabling consequences. The present study aimed to assess the effect of preoperative anti-TNF therapy on the length of resected bowel and identify risk factors for postoperative morbidity following ileocolic resection for CD.
Patients undergoing elective ileocolic resection for CD were included prospectively. Medical variables including demographics, Montréal classification, preoperative treatment, surgical details and 30-day postoperative morbidity were collected. Potential impact of preoperative anti-TNF treatment on length of ileocolic specimen and risk factors for postoperative morbidity were investigated.
One hundred and eight-four patients were included in this study, and 66 (35.9%) of them received anti-TNF agents within 8 weeks prior to surgery. Primary anastomosis was performed in 145 patients (78.8%). The mean length of resected intestine was 10 cm shorter in subjects receiving preoperative anti-TNF treatment than those without preoperative anti-TNF therapy ( < 0.001). The rates of postoperative overall, infectious and intra-abdominal septic morbidity were 29.9%, 19.0% and 7.6%, respectively. In multivariate analysis, anti-TNF therapy < 8 weeks before surgery was independently associated with a shorter length of resected bowel but didn't increase overall and septic complications, while systemic steroids use within 8 weeks prior to surgery independently increased overall complications and intra-abdominal sepsis.
Preoperative anti-TNF therapy was associated with a shorter length of resected bowel but not the overall and septic postoperative complications in ileocolic resection for CD. Weaning off systemic steroids before surgery may improve postoperative outcomes in patients with CD.
克罗恩病（CD）的大量或反复肠道切除术可能导致致残后果。本研究旨在评估术前抗 TNF 治疗对 CD 回肠结肠切除术切除肠段长度的影响，并确定术后发病率的危险因素。
前瞻性纳入接受择期回肠结肠切除术治疗 CD 的患者。收集了包括人口统计学、蒙特利尔分类、术前治疗、手术细节和 30 天术后发病率在内的医疗变量。研究了术前抗 TNF 治疗对回肠结肠标本长度的潜在影响以及术后发病率的危险因素。
本研究共纳入 184 例患者，其中 66 例（35.9%）在手术前 8 周内接受了抗 TNF 药物治疗。145 例患者进行了一期吻合术。接受术前抗 TNF 治疗的患者切除的肠段比未接受术前抗 TNF 治疗的患者平均短 10cm（<0.001）。术后总发病率、感染性发病率和腹腔内脓毒症发病率分别为 29.9%、19.0%和 7.6%。多变量分析显示，手术前 8 周内使用抗 TNF 治疗与切除肠段较短有关，但不会增加总发病率和脓毒症并发症，而手术前 8 周内使用全身皮质类固醇与总并发症和腹腔内脓毒症独立相关。
术前抗 TNF 治疗与 CD 回肠结肠切除术切除肠段较短有关，但与总发病率和脓毒症术后并发症无关。在手术前停用全身皮质类固醇可能会改善 CD 患者的术后结果。
