Department of General Surgery, The Second Xiangya Hospital of Central South University, Changsha, 410011, China.
Int J Colorectal Dis. 2024 Sep 24;39(1):150. doi: 10.1007/s00384-024-04725-5.
Before the era of biological agents, most Crohn's disease patients required at least one intestinal resection surgery after diagnosis. However, clinical data regarding the abdominal surgery rates for Crohn's disease patients in the era of biological agents is not yet fully clear and needs to be updated.
We retrospectively collected clinical data from 1115 Crohn's disease patients diagnosed and treated medically at The Second Xiangya Hospital of Central South University from January 2016 to January 2024. Using abdominal intestinal resection surgery as a clinical outcome, propensity score matching was employed to eliminate confounding factors. We explored the timing and proportion of abdominal surgery in patients with different Montreal classifications of Crohn's disease during the natural course of the disease, as well as the impact of the duration of the natural course and the use of biological agents on surgical outcomes.
Montreal classification type B had the greatest impact on Crohn's disease surgery, especially with a higher proportion of type B3 patients undergoing surgery. Type A1 Crohn's disease patients underwent surgery earlier than types A2 and A3. The occurrence of behavior changes (B Change) during the natural course of the disease is a poor prognostic signal, indicating a significantly increased likelihood of surgery. The duration of the natural course from the onset of gastrointestinal symptoms to diagnosis and clinical observation outcomes did not directly affect the likelihood of surgery in Crohn's disease patients. Compared with Crohn's disease patients who did not receive biological agents, the surgery rate was significantly lower in patients who used biological agents. Additionally, Crohn's disease patients who received biological agents within 1 month of diagnosis had a significantly lower likelihood of undergoing surgical intervention. Moreover, Crohn's disease patients who received biological agent treatment within 19 months of the onset of gastrointestinal symptoms also had a significantly lower likelihood of undergoing surgery than other Crohn's disease patients.
In the era of biological agents, the risk of surgical intervention varies among Crohn's disease patients with different Montreal classifications, particularly when there is type B3 disease or a B Change. Clinicians should pay closer attention to surgical indications in such cases. For Crohn's disease patients, shortening the natural course before diagnosis and early use of biological agents after diagnosis can significantly reduce the risk of abdominal surgery.
在生物制剂时代之前，大多数克罗恩病患者在确诊后至少需要进行一次肠道切除术。然而，关于生物制剂时代克罗恩病患者的腹部手术率的临床数据尚不完全清楚，需要更新。
我们回顾性地收集了 2016 年 1 月至 2024 年 1 月在中南大学湘雅二医院接受医学诊断和治疗的 1115 例克罗恩病患者的临床数据。采用腹部肠道切除术作为临床结局，采用倾向评分匹配消除混杂因素。我们探讨了不同蒙特利尔分类的克罗恩病患者在疾病自然病程中的腹部手术时机和比例，以及疾病自然病程持续时间和生物制剂使用对手术结局的影响。
蒙特利尔分类类型 B 对克罗恩病手术的影响最大，尤其是 B3 型患者的手术比例更高。A1 型克罗恩病患者比 A2 和 A3 型更早进行手术。疾病自然病程中行为改变（B 改变）的发生是一个不良预后信号，表明手术的可能性显著增加。从胃肠道症状出现到诊断和临床观察结果的自然病程持续时间并不直接影响克罗恩病患者手术的可能性。与未接受生物制剂的克罗恩病患者相比，使用生物制剂的患者手术率明显较低。此外，克罗恩病患者在诊断后 1 个月内使用生物制剂治疗的手术干预可能性显著降低。而且，克罗恩病患者在胃肠道症状出现后 19 个月内使用生物制剂治疗的手术可能性也明显低于其他克罗恩病患者。
在生物制剂时代，不同蒙特利尔分类的克罗恩病患者手术干预的风险不同，特别是存在 B 型 3 疾病或 B 改变时。临床医生应在这些情况下密切关注手术指征。对于克罗恩病患者，缩短诊断前的自然病程和诊断后尽早使用生物制剂可以显著降低腹部手术的风险。
