Wolff B G, Beart R W, Frydenberg H B, Weiland L H, Agrez M V, Ilstrup D M
Dis Colon Rectum. 1983 Apr;26(4):239-43. doi: 10.1007/BF02562486.
It has long been a fundamental principle of surgical therapy for Crohn's disease to remove all disease prior to doing an anastomosis. The authors recently noted with concern an article describing a series of patients demonstrating that residual involvement of anastomotic microscopic disease had no significant effect on the recurrence rate at the anastomosis. Examining their own series of 710 patients undergoing surgery for Crohn's disease, the authors found 42 patients with residual anastomotic disease. The criteria for involvement were more specific than that used in the above article and included microscopic mucosal disease. The recurrence rate within the follow-up period of eight years in patients with only microscopic involvement was 89.4 per cent. This was significantly higher than the institutional recurrence rate for Crohn's resections, previously reported, of 55 per cent at ten years. The authors feel that clear margins should be obtained in resections for Crohn's disease, if at all feasible.
长期以来，克罗恩病外科治疗的一项基本原则是在进行吻合术之前清除所有病灶。作者最近关切地注意到一篇文章，该文章描述了一系列患者，表明吻合口微观病灶的残留对吻合口复发率没有显著影响。在检查他们自己的710例接受克罗恩病手术的患者系列时，作者发现42例患者存在吻合口残留病灶。受累标准比上述文章中使用的更具体，包括微观黏膜病灶。仅存在微观受累的患者在八年随访期内的复发率为89.4%。这显著高于先前报道的该机构克罗恩病切除术十年时55%的复发率。作者认为，只要可行，在克罗恩病切除术中应获得切缘阴性。
