Division of Colon and Rectal Surgery, Mayo Clinic, 200 1St Street SW, Rochester, MN, 55905, USA.
The Robert D. and Patricia E. Kern Center for Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA.
Langenbecks Arch Surg. 2024 Apr 19;409(1):132. doi: 10.1007/s00423-024-03324-w.
Operative options for duodenal Crohn's disease include bypass, stricturoplasty, or resection. What factors are associated with operation selection and whether differences exist in outcomes is unknown.
Patients with duodenal Crohn's disease requiring operative intervention across a multi-state health system were identified. Patient and operative characteristics, short-term surgical outcomes, and the need for future endoscopic or surgical management of duodenal Crohn's disease were analyzed.
40 patients underwent bypass (n = 26), stricturoplasty (n = 8), or resection (n = 6). Median age of diagnosis of Crohn's disease was 23.5 years, and over half of the patients had undergone prior surgery for CD. Operation type varied by the most proximal extent of duodenal involvement. Patients with proximal duodenal CD underwent bypass operations more commonly than those with mid- or distal duodenal disease (p = 0.03). Patients who underwent duodenal stricturoplasty more often required concomitant operations for other sites of small bowel or colonic CD (63%) compared to those who underwent bypass (39%) or resection (33%). No patients required subsequent surgery for duodenal CD at a median follow-up of 2.8 years, but two patients required endoscopic dilation (n = 1 after stricturoplasty, n = 1 after resection).
Patients who require surgery for duodenal Crohn's disease appear to have an aggressive Crohn's disease phenotype, represented by a younger age of diagnosis and a high rate of prior resection for Crohn's disease. Choice of operation varied by proximal extent of duodenal Crohn's disease.
十二指肠克罗恩病的手术选择包括旁路、缩窄成形术或切除术。哪些因素与手术选择有关，以及结果是否存在差异尚不清楚。
在一个多州医疗系统中，确定了需要手术干预的十二指肠克罗恩病患者。分析了患者和手术特点、短期手术结果，以及未来是否需要内镜或手术治疗十二指肠克罗恩病。
40 名患者接受了旁路手术（n=26）、缩窄成形术（n=8）或切除术（n=6）。克罗恩病诊断的中位年龄为 23.5 岁，超过一半的患者曾因 CD 接受过手术。手术类型因十二指肠受累的最近端范围而异。近端十二指肠 CD 患者更常接受旁路手术，而不是中或远端十二指肠疾病（p=0.03）。与接受旁路（39%）或切除（33%）手术的患者相比，接受十二指肠缩窄成形术的患者更常需要同时进行其他小肠或结肠 CD 部位的手术（63%）。在中位随访 2.8 年时，没有患者因十二指肠 CD 而需要后续手术，但有 2 名患者需要内镜扩张（1 例在缩窄成形术后，1 例在切除术后）。
需要手术治疗十二指肠克罗恩病的患者似乎具有侵袭性的克罗恩病表型，表现为诊断年龄较小和克罗恩病切除率较高。手术选择因十二指肠克罗恩病的近端范围而异。
