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原发性回盲部克罗恩病手术治疗后主要并发症的危险因素。一项拉丁美洲多中心研究经验。

Risk factors for major complications after surgical treatment of primary ileocecal Crohn's disease. A multicentric Latin American experience.

作者信息

Avellaneda Nicolás, Rodrigues Coy Claudio Saddy, Sarubbi Fillmann Henrique, Saad-Hossne Rogerio, Muñoz Juan Pablo, García-Duperly Rafael, Bellolio Felipe, Rotholtz Nicolás, Rossi Gustavo, Marquez V Juan Ricardo, Cillo Mariano, Lacerda-Filho Antonio, Carrie Augusto, Yuki Maruyama Beatriz, Sarubbi Fillmann Lucio, Silvino Craveiro Marcela Maria, Ferro Ezequiel, Londoño-Schimmer Eduardo, Iglesias Andrés, Bras Harriott Camila, Campana Juan Pablo, Londoño Estrada Daniel, Balachandran Rogini, Kotze Paulo Gustavo

机构信息

General Surgery Department, Hospital Universitario CEMIC, Argentina; Colorectal Surgery Department, Aarhus University Hospital, Denmark.

Colorectal Surgery Unit, Campinas State University (UNICAMP), Campinas, Brazil.

出版信息

Cir Esp (Engl Ed). 2023 Dec;101(12):824-832. doi: 10.1016/j.cireng.2023.05.002. Epub 2023 May 25.

Abstract

INTRODUCTION

Complications after ileocecal resection for Crohn's disease (CD) are frequent. The aim of this study was to analyze risk factors for postoperative complications after these procedures.

MATERIALS AND METHODS

We conducted a retrospective analysis of patients treated surgically for Crohn's disease limited to the ileocecal region during an 8-year period at 10 medical centers specialized in inflammatory bowel disease (IBD) in Latin America. Patients were allocated into 2 groups: those who presented major postoperative complications (Clavien-Dindo > II), the "postoperative complication" (POC) group; and those who did not, the "no postoperative complication" (NPOC) group. Preoperative characteristics and intraoperative variables were analyzed to identify possible factors for POC.

RESULTS

In total, 337 patients were included, with 51 (15.13%) in the POC cohort. Smoking was more prevalent among the POC patients (31.37 vs. 17.83; P = .026), who presented more preoperative anemia (33.33 vs. 17.48%; P = .009), required more urgent care (37.25 vs. 22.38; P = .023), and had lower albumin levels. Complicated disease was associated with higher postoperative morbidity. POC patients had a longer operative time (188.77 vs. 143.86 min; P = .005), more intraoperative complications (17.65 vs. 4.55%; P < .001), and lower rates of primary anastomosis. In the multivariate analysis, both smoking and intraoperative complications were independently associated with the occurrence of major postoperative complications.

CONCLUSION

This study shows that risk factors for complications after primary ileocecal resections for Crohn's disease in Latin America are similar to those reported elsewhere. Future efforts in the region should be aimed at improving these outcomes by controlling some of the identified factors.

摘要

引言

克罗恩病(CD)行回盲部切除术后并发症很常见。本研究的目的是分析这些手术术后并发症的危险因素。

材料与方法

我们对拉丁美洲10家专门治疗炎症性肠病(IBD)的医疗中心在8年期间因克罗恩病局限于回盲部而接受手术治疗的患者进行了回顾性分析。患者被分为两组:出现术后严重并发症(Clavien-Dindo>Ⅱ)的患者,即“术后并发症”(POC)组;未出现并发症的患者,即“无术后并发症”(NPOC)组。分析术前特征和术中变量以确定可能导致POC的因素。

结果

共纳入337例患者,其中POC队列中有51例(15.13%)。POC患者中吸烟更为普遍(31.37对17.83;P = 0.026),术前贫血更多(33.33对17.48%;P = 0.009),需要更紧急的治疗(37.25对22.38;P = 0.023),且白蛋白水平较低。复杂疾病与术后更高的发病率相关。POC患者的手术时间更长(188.77对143.86分钟;P = 0.005),术中并发症更多(17.65对4.55%;P < 0.001),一期吻合率更低。在多变量分析中,吸烟和术中并发症均与术后严重并发症的发生独立相关。

结论

本研究表明,拉丁美洲克罗恩病行初次回盲部切除术后并发症的危险因素与其他地方报道的相似。该地区未来的努力应旨在通过控制一些已确定的因素来改善这些结果。

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