克罗恩病中被排除在外的直肠的长期结局：一项多中心国际研究。

Long-Term Outcomes of the Excluded Rectum in Crohn's Disease: A Multicenter International Study.

机构信息

Division of Gastroenterology and Hepatology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.

University of Chicago Medicine Inflammatory Bowel Disease Center, Chicago, IL, USA.

出版信息

Inflamm Bowel Dis. 2023 Mar 1;29(3):417-422. doi: 10.1093/ibd/izac099.

DOI:10.1093/ibd/izac099

PMID:35522225

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10210615/

Abstract

BACKGROUND

Many patients with Crohn's disease (CD) require fecal diversion. To understand the long-term outcomes, we performed a multicenter review of the experience with retained excluded rectums.

METHODS

We reviewed the medical records of all CD patients between 1990 and 2014 who had undergone diversionary surgery with retention of the excluded rectum for at least 6 months and who had at least 2 years of postoperative follow-up.

RESULTS

From all the CD patients in the institutions' databases, there were 197 who met all our inclusion criteria. A total of 92 (46.7%) of 197 patients ultimately underwent subsequent proctectomy, while 105 (53.3%) still had retained rectums at time of last follow-up. Among these 105 patients with retained rectums, 50 (47.6%) underwent reanastomosis, while the other 55 (52.4%) retained excluded rectums. Of these 55 patients whose rectums remained excluded, 20 (36.4%) were symptom-free, but the other 35 (63.6%) were symptomatic. Among the 50 patients who had been reconnected, 28 (56%) were symptom-free, while 22(44%) were symptomatic. From our entire cohort of 197 cases, 149 (75.6%) either ultimately lost their rectums or remained symptomatic with retained rectums, while only 28 (14.2%) of 197, and only 4 (5.9%) of 66 with initial perianal disease, were able to achieve reanastomosis without further problems. Four patients developed anorectal dysplasia or cancer.

CONCLUSIONS

In this multicenter cohort of patients with CD who had fecal diversion, fewer than 15%, and only 6% with perianal disease, achieved reanastomosis without experiencing disease persistence.

摘要

背景

许多克罗恩病（CD）患者需要粪便改道。为了了解长期结果，我们对保留的切除直肠的经验进行了多中心回顾。

方法

我们回顾了 1990 年至 2014 年间接受过保留切除直肠至少 6 个月且术后随访至少 2 年的所有 CD 患者的病历。

结果

在所有机构数据库中的 CD 患者中，有 197 名符合我们所有的纳入标准。共有 197 名患者中有 92 名（46.7%）最终接受了后续的直肠切除术，而在最后一次随访时，仍有 105 名（53.3%）保留了直肠。在这 105 名保留直肠的患者中，50 名（47.6%）接受了再吻合术，而其他 55 名（52.4%）保留了切除的直肠。在这 55 名直肠被保留的患者中，20 名（36.4%）无症状，但其他 35 名（63.6%）有症状。在接受再连接的 50 名患者中，28 名（56%）无症状，而 22 名（44%）有症状。在我们的 197 例患者中，有 149 例（75.6%）最终失去了直肠，或保留直肠时仍有症状，而只有 28 例（14.2%），且仅有 66 例中初始肛周疾病患者的 4 例（5.9%）能够在没有进一步问题的情况下实现再吻合。4 名患者发生肛门直肠发育不良或癌症。