Aeberhard P, Berchtold W, Riedtmann H J, Stadelmann G
Department of Surgery, Kantonsspital, Aarau, Switzerland.
Dis Colon Rectum. 1996 Jan;39(1):80-7. doi: 10.1007/BF02048274.
This is a study of the long-term course of surgically treated Crohn's disease designed to identify prognostic factors predictive of the time course and probability of surgical recurrence.
The study is based on the records of 101 patients admitted to our institution for surgical treatment of Crohn's disease from January 1, 1970 to December 31, 1985. Follow-up was complete in 97 (96 percent) and incomplete in 4 patients. Median follow-up from the date of first operation was 13.25 years. The cumulative probability of requiring surgical treatment for recurrent disease was calculated using the life table method and further analyzed with the log-rank test and Cox regression.
The time to reoperation in this series was not significantly influenced by sex, age at onset of symptoms, age at diagnosis, age at first operation, anatomic location, and number of sites involved at the time of first operation. The only variable that had a statistically significant effect on the time to reoperation was characterization of disease at the time of operation as being perforating (P) opposed to nonperforating (NP). Median interval between the first and second intestinal operation was 1.7 years for the P group and 13 years for the NP group (P value, 0.005), and the median time between any two operations undergone during the study period was 2 years for the P group and 9.9 years for the NP group (P = 0.0002). The risk of having to undergo reoperation for recurrence was greatest during the first two years after an operation, and this was mainly because of a short time to surgical recurrence in the P group of indications. Therefore, the yearly hazard of requiring further surgery was maintained at approximately 5 percent.
The cumulative probability of requiring a reoperation for patients undergoing surgery for the P type of Crohn's disease is significantly different from that of patients with NP indications. The risk of having to undergo further surgery is particularly high during the first two years following an operation for perforating disease. The concept of a relatively aggressive perforating type of Crohn's disease and a more indolent nonperforating type is confirmed by the results of this study.
本研究旨在探讨手术治疗克罗恩病的长期病程，以确定预测病程和手术复发概率的预后因素。
本研究基于1970年1月1日至1985年12月31日期间在我院接受克罗恩病手术治疗的101例患者的记录。97例（96%）患者随访完整，4例患者随访不完整。从首次手术日期起的中位随访时间为13.25年。采用寿命表法计算复发性疾病需要手术治疗的累积概率，并进一步用对数秩检验和Cox回归分析。
本系列患者再次手术时间不受性别、症状出现年龄、诊断年龄、首次手术年龄、解剖位置以及首次手术时受累部位数量的显著影响。对再次手术时间有统计学显著影响的唯一变量是手术时疾病表现为穿孔性（P）与非穿孔性（NP）。P组首次和第二次肠道手术的中位间隔时间为1.7年，NP组为13年（P值为0.005），研究期间P组任意两次手术的中位时间为2年，NP组为9.9年（P = 0.0002）。手术后头两年因复发而必须再次手术的风险最大，这主要是因为P组适应症的手术复发时间较短。因此，每年需要进一步手术的风险维持在约5%。
接受P型克罗恩病手术的患者需要再次手术的累积概率与NP适应症患者显著不同。对于穿孔性疾病手术后的头两年，必须接受进一步手术的风险特别高。本研究结果证实了克罗恩病存在相对侵袭性的穿孔型和较惰性的非穿孔型这一概念。
