Martin G, Heyen F, Dubé S
Hôpital Maisonneuve-Rosemont, Montréal, Québec, Canada.
Ann Chir. 1994;48(8):685-90.
The surgical treatment of complications of Crohn's disease is often postponed, because of the threat of short gut and high recurrence rates. We reviewed retrospectively 286 cases of intestinal resection to evaluate factors influencing the recurrence of Crohn's disease after surgery. Recurrence was defined as the need for reoperation. Risk factors used as independent variables are all subject of controversy in recent literature. These factors included: smoking, blood transfusion, contamination, localisation of the disease, length of resection, microscopic margins and the duration of follow-up. A logistic regression model was calculated, using recurrence as the dependent variable. The mean follow-up is 55 months. Kaplan Meier was used to measure the recurrence rate. Duration of follow-up is the most important variable. The length of resection and the positive margins can statistically predict recurrence (p = 0.046 et p = 0.016), both having a predictive value of 72%. A resection with clear margins decreases the recurrence rate significantly (15%) (p = 0.0025).
由于短肠风险和高复发率，克罗恩病并发症的外科治疗常常被推迟。我们回顾性分析了286例肠切除术病例，以评估影响克罗恩病术后复发的因素。复发定义为需要再次手术。作为自变量的危险因素在最近的文献中均存在争议。这些因素包括：吸烟、输血、污染、疾病部位、切除长度、显微镜下切缘以及随访时间。以复发作为因变量计算了逻辑回归模型。平均随访时间为55个月。采用Kaplan Meier法测量复发率。随访时间是最重要的变量。切除长度和切缘阳性在统计学上可预测复发（p = 0.046和p = 0.016），两者的预测价值均为72%。切缘清晰的切除术可显著降低复发率（15%）（p = 0.0025）。
