Department of Colon and Rectal Surgery, Mayo Clinic, Rochester, MN.
Division of Colon and Rectal Surgery, Mayo Clinic, Jacksonville, FL.
Surgery. 2022 Aug;172(2):522-529. doi: 10.1016/j.surg.2022.01.046. Epub 2022 Mar 23.
Minimally invasive ileocolic resection for complicated Crohn disease, defined as penetrating Crohn disease associated with intra-abdominal fistula, abscess, or phlegmon, is challenging. In addition, the impact of the minimally invasive approach on postoperative outcomes is still debated. This study aimed to compare the intraoperative and postoperative outcomes of minimally invasive ileocolic resection for complicated versus uncomplicated Crohn disease.
A retrospective analysis of all consecutive adult patients with Crohn disease undergoing minimally invasive ileocolic resection from 2014 to 2021 was performed. Perioperative outcomes were compared between patients with complicated Crohn disease (complicated group) and patients without these lesions (uncomplicated group).
Among the 274 patients undergoing minimally invasive ileocolic resection for Crohn disease, 101 (36.9%) had a robotic approach, and 84 (30.7%) had complicated Crohn disease. Complicated patients were more frequently malnourished (32.1% vs 16.1%, P = .004) and had more frequent previous bowel resections for Crohn disease (22.1% vs 9.5%, P = .002). There were no differences between both groups regarding intraoperative complications (1.1% uncomplicated group vs 2.4% complicated group, P = .463), conversion rate (2.6% uncomplicated group vs 4.8% complicated group, P = .463), postoperative morbidity (27.4% uncomplicated group vs 34.5% complicated group, P = .231), intra-abdominal septic complications (4.2% uncomplicated group vs 7.1% complicated group, P = .309), and length of stay (3.8 ± 2.0 days uncomplicated group vs 4.2 ± 3.0 complicated group, P = .188).
Minimally invasive ileocolic resection for complicated Crohn disease is safe and feasible. Future prospective studies are needed to confirm these results.
对于复杂克罗恩病（定义为穿透性克罗恩病伴腹腔内瘘、脓肿或蜂窝织炎），微创回肠结肠切除术具有挑战性。此外，微创方法对术后结果的影响仍存在争议。本研究旨在比较微创回肠结肠切除术治疗复杂与不复杂克罗恩病的术中及术后结果。
对 2014 年至 2021 年期间连续接受微创回肠结肠切除术治疗的所有克罗恩病成年患者进行回顾性分析。比较复杂克罗恩病患者（复杂组）和无这些病变的患者（不复杂组）的围手术期结果。
在 274 例接受微创回肠结肠切除术治疗克罗恩病的患者中，101 例（36.9%）采用机器人方法，84 例（30.7%）患有复杂克罗恩病。复杂组患者更常出现营养不良（32.1%比 16.1%，P=0.004）和因克罗恩病接受过更多次肠切除术（22.1%比 9.5%，P=0.002）。两组患者在术中并发症（无并发症组 1.1%比复杂组 2.4%，P=0.463）、转化率（无并发症组 2.6%比复杂组 4.8%，P=0.463）、术后发病率（无并发症组 27.4%比复杂组 34.5%，P=0.231）、腹腔感染并发症（无并发症组 4.2%比复杂组 7.1%，P=0.309）和住院时间（无并发症组 3.8±2.0 天比复杂组 4.2±3.0 天，P=0.188）方面均无差异。
微创回肠结肠切除术治疗复杂克罗恩病是安全可行的。未来需要前瞻性研究来证实这些结果。
