克罗恩病患者手术现状及复发危险因素分析

发布时间：2018-08-15 18:43

【摘要】：背景和目的克罗恩病(Crohn's disease,CD)是一种病因尚不清楚的慢性非特异性肠道炎性疾病。在生物制剂时代,手术方式在不断进展,CD相关的手术率明显下降。然而,仍有46.6%的CD患者自诊断10年内需行手术治疗,且1年内约20-40%出现术后复发(Postoperative recurrence,POR),而关于影响POR危险因素的研究结论尚不统一。CD患者因长期消耗和炎症活动等原因常常出现术后并发症。本研究旨在分析CD的手术现状、术后未用药患者的长期复发情况、POR相关的危险因素及术后并发症。方法:回顾性分析118例行肠切除术的CD患者,采用卡方检验或Fisher精确概率法比较计数资料,Log-rank检验和多元Cox回归模型分别进行单因素和多因素分析析。P0.05为有统计学意义。结果:1.一般情况1.1基本临床资料共纳入118例CD患者,28.8%(34/118)为女性患者,中位确诊年龄为36.5(17.0)岁。49.2%(58/118)的患者为未用药组。1.2手术现状:(1)手术方式:2011-2016年,44.9%行腹腔镜手术,较2003-2010年显著降低(79.3%),p==0.001。(2)吻合方式:2011-2016年,69.7%行吻合器-侧侧吻合术,较2003-2010年显著升高(0),p0.0001。2.POR2.1 POR 率118例CD患者中位随访时间为14.3(27.0)月,术后1年、3年、5年、9年累积复发率为 43.3%、63.7%、74.1%和 83.8%。58例未用药组术后1年、3年、5年、9年累积复发率分别为48.1%、66.4%、77.1%和 87.7%。2.2单变量分析合并肠外表现、中性粒细胞百分比≥75%、C-反应蛋白≥10mg/L和术前使用硫唑嘌呤(Azathioprine,AZA)对POR的影响有统计学差异(p0.05)。2.3多变量分析术后用药显著降低POR率(p0.05),中性粒细胞百分比≥75%和血红蛋白90g/L 显著增加 POR(p0.05)。3.术后并发症14.4%的CD患者出现腹腔感染性并发症。4.比较英夫利昔单抗(Infliximab,IFX)+AZA和单用AZA预防POR20例IFX+AZA组中位随访时间23.3(23.6)月,50%(10/20)的患者出现POR,术后1年、2年、3年累积复发率为20.5%、43.2%,58.4%;29例术后AZA组中位随访时间16.3(22.8)月,48.3%(14/29)的患者出现POR,术后1年、2年、3年累积复发率为42.3%、53.8%和53.8%。两组术后累积复发率无明显差异(p=0.969)。5.沙利度胺预防POR的初步探索术后3例患者使用沙利度胺50-150mg/d预防CD复发,其中1例患者在用药3个月后出现临床复发,另2例患者则至随访终点仍处于术后缓解期。结论吻合器-侧侧吻合术是目前外科治疗CD的主要吻合方式。CD患者术后长期病程预后不佳,需及时有效的干预措施。术前中性粒细胞百分比升高、血红蛋白降低和术后未预防用药POR的独立危险因素。IFX+AZA预防POR的效果与单用AZA相近。沙利度胺在预防POR中有一定的应用价值,需进一步的研究证实。CD术后腹腔感染性并发症发生率高。
[Abstract]:Background and objective Crohn's disease (CD) is a chronic nonspecific inflammatory disease with unknown etiology. In the age of biological agents, the rate of CD-related surgery has decreased significantly. However, 46.6% of patients with CD have been diagnosed for 10 years and need to be treated surgically. Within one year, Postoperative recurrence occurred in about 20-40% of the patients. However, the results of the study on the risk factors affecting POR were not uniform. The postoperative complications were often found in patients with CD due to long-term consumption and inflammatory activity. The purpose of this study was to analyze the surgical status of CD, the long term recurrence of untreated patients and the risk factors associated with POR and postoperative complications. Methods: the data of 118 CD patients undergoing enterectomy were analyzed retrospectively. The count data were compared by chi-square test or Fisher accurate probability method. Single factor analysis and multivariate Cox regression model were used to analyze the single factor and the multivariate Cox regression model respectively. The result is 1: 1. General situation 1.1 basic clinical data included 118 cases of CD patients with 28.8% (34 / 118) of female patients. The median age of diagnosis was 36.5 (17.0) years old. 49.2% (58 / 118) of the patients was the non-medication group. 1.2 operation status: (1) the operation mode: 2011-2016, 44.9% of the patients underwent laparoscopic surgery. Compared with 2003-2010, it was significantly lower (79.3%) than that of 2003-2010 (79.3%). (2) the anastomosis mode: from 2011-2016 to 2016 was 69.7%, which was significantly higher than that in 2003-2010 (0) p 0.0001.2.POR2.1 POR rate was 14.3 (27.0) months in 118 patients with CD. The cumulative recurrence rates of 43.3%, 63.7% and 83.8% in the group of 1, 3, 5 and 9 years after operation were 48.1% and 83.8%, respectively. The accumulative recurrence rates were 48.1%, 66.4% and 77.1%, respectively, and 87.7%, respectively, in the group of untreated drugs for 1 year, 3 years, 5 years and 9 years, respectively. The percentage of neutrophilic granulocytes 鈮，

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