吻合器辅助的Kono-S吻合术是克罗恩病术后内镜复发的保护因素吗？一项单中心回顾性队列研究。

Is stapled Kono-S anastomosis a protective factor against postoperative endoscopic recurrence in Crohn disease? A single-center, retrospective cohort study.

作者信息

Song Tianrun, Chen Yang, Wang Liqun, Zhang Chunjie, Zhou Changsheng, Diao Yanqing, Gong Jianfeng, Cao Lei, Zhu Weiming, Duan Ming, Li Yi

机构信息

Department of General Surgery, Center for Inflammatory Bowel Diseases, The Affiliated Jinling Hospital of Nanjing Medical University, Nanjing, China.

Department of Injury and Illness Management, Jinling Hospital, School of Medicine, Nanjing University, Nanjing, China.

出版信息

J Gastrointest Surg. 2025 Mar;29(3):101941. doi: 10.1016/j.gassur.2024.101941. Epub 2025 Jan 6.

DOI:10.1016/j.gassur.2024.101941

PMID:39778702

Abstract

BACKGROUND

Handsewn Kono-S anastomosis is safe and associated with a reduction in postoperative recurrence (POR) in Crohn disease (CD). This study aimed to investigate the advantages of stapled Kono-S anastomosis in patients with CD who underwent intestinal anastomosis.

METHODS

Patients with CD who underwent intestinal anastomosis were reviewed via a prospectively maintained database. Patients who underwent conventional stapled side-to-side anastomosis were classified into the conventional group, and those who underwent stapled Kono-S anastomosis were classified into the Kono-S group. The primary endpoint was modified endoscopic recurrence (mER; ≥i2b). Other endpoints were endoscopic recurrence (ER; ≥i2); severe ER (i3 and i4); intra- and postoperative outcomes, including morbidity and hospital stay; and cross-sectional parameters. Multivariate logistic regression analysis was performed to assess the independent risk factors for mER.

RESULTS

Between 2020 and 2023, 199 patients (63 in the Kono-S group) were included in this study. After matching the 63 patients in each group, the overall rates of mER, ER, and severe ER were 19.0%, 24.6%, and 8.7%, respectively. The mER, ER, and severe ER rates were lower in the Kono-S group than in the conventional group (12.7% vs 25.4% [P =.07], 20.6% vs 28.6% [P =.30], and 6.3% vs 11.1% [P =.34], respectively). Multivariate analysis indicated that stapled Kono-S anastomosis (odds ratio [OR], 0.35; 95% CI, 0.12-0.98; P =.047) was an independent protective factor for mER, whereas male gender (OR, 7.75; 95% CI, 1.50-40.00; P =.01) and BMI of <18.5 kg/m (OR, 3.27; 95% CI, 1.11-9.67; P =.03) were independent risk factors for mER.

CONCLUSION

Stapled Kono-S anastomosis is safe for patients with CD. However, stapled Kono-S anastomosis may not be a protective factor against POR compared with conventional stapled side-to-side anastomosis.

摘要

背景

手工缝合的小野 - S 吻合术是安全的，且与克罗恩病（CD）术后复发率降低相关。本研究旨在探讨吻合器行小野 - S 吻合术在接受肠道吻合术的 CD 患者中的优势。

方法

通过前瞻性维护的数据库对接受肠道吻合术的 CD 患者进行回顾性分析。接受传统吻合器侧侧吻合术的患者被分为传统组，接受吻合器小野 - S 吻合术的患者被分为小野 - S 组。主要终点是改良内镜复发（mER；≥i2b）。其他终点包括内镜复发（ER；≥i2）、严重内镜复发（i3 和 i4）、术中和术后结局，包括发病率和住院时间，以及横断面参数。进行多因素逻辑回归分析以评估 mER 的独立危险因素。

结果

2020 年至 2023 年期间，本研究纳入了 199 例患者（小野 - S 组 63 例）。在每组匹配 63 例患者后，mER、ER 和严重 ER 的总体发生率分别为 19.0%、24.6%和 8.7%。小野 - S 组的 mER、ER 和严重 ER 发生率低于传统组（分别为 12.7%对 25.4%[P = 0.07]、20.6%对 28.6%[P = 0.30]、6.3%对 11.1%[P = 0.34]）。多因素分析表明，吻合器小野 - S 吻合术（比值比[OR]，0.35；95%置信区间，0.12 - 0.98；P = 0.047）是 mER 的独立保护因素，而男性性别（OR，7.75；95%置信区间，1.50 - 40.00；P = 0.01）和体重指数<18.5 kg/m²（OR，3.27；95%置信区间, 1.11 - 9.67；P = 0.03）是 mER 的独立危险因素。