Abstract：
BACKGROUND: Intra-abdominal abscesses complicating Crohn\'s disease [CD] are a challenging situation. Their management, during hospitalisation and after resolution, is still unclear.
METHODS: Adult patients with CD complicated with intra-abdominal abscess. who required hospitalisation, were included from the prospectively maintained ENEIDA registry from GETECCU. Initial strategy effectiveness and safety to resolve abscess was assessed. Survival analysis was performed to evaluate recurrence risk. Predictive factors associated with resolution were evaluated by multivariate regression and predictive factors associated with recurrence were assessed by Cox regression.
RESULTS: In all, 520 patients from 37 Spanish hospitals were included; 322 [63%] were initially treated with antibiotics alone, 128 [26%] with percutaneous drainage, and 54 [17%] with surgical drainage. The size of the abscess was critical to the effectiveness of each treatment. In abscesses < 30 mm, the antibiotic was as effective as percutaneous or surgical drainage. However, in larger abscesses, percutaneous or surgical drainage was superior. In abscesses > 50 mm, surgery was superior to percutaneous drainage, although it was associated with a higher complication rate. After abscess resolution, luminal resection was associated with a lower 1-year abscess recurrence risk [HR 0.43, 95% CI 0.24-0.76]. However, those patients who initiated anti-TNF therapy had a similar recurrence risk whether luminal resection had been performed.
CONCLUSIONS: Small abscesses [<30mm] can be managed with antibiotics alone; larger ones require drainage. Percutaneous drainage will be effective and safer than surgery in many cases. After discharge, anti-TNF therapy reduces abscess recurrence risk in a similar way to bowel resection.
METHODS: Adult patients with CD complicated with intra-abdominal abscess. who required hospitalisation, were included from the prospectively maintained ENEIDA registry from GETECCU. Initial strategy effectiveness and safety to resolve abscess was assessed. Survival analysis was performed to evaluate recurrence risk. Predictive factors associated with resolution were evaluated by multivariate regression and predictive factors associated with recurrence were assessed by Cox regression.
RESULTS: In all, 520 patients from 37 Spanish hospitals were included; 322 [63%] were initially treated with antibiotics alone, 128 [26%] with percutaneous drainage, and 54 [17%] with surgical drainage. The size of the abscess was critical to the effectiveness of each treatment. In abscesses < 30 mm, the antibiotic was as effective as percutaneous or surgical drainage. However, in larger abscesses, percutaneous or surgical drainage was superior. In abscesses > 50 mm, surgery was superior to percutaneous drainage, although it was associated with a higher complication rate. After abscess resolution, luminal resection was associated with a lower 1-year abscess recurrence risk [HR 0.43, 95% CI 0.24-0.76]. However, those patients who initiated anti-TNF therapy had a similar recurrence risk whether luminal resection had been performed.
CONCLUSIONS: Small abscesses [<30mm] can be managed with antibiotics alone; larger ones require drainage. Percutaneous drainage will be effective and safer than surgery in many cases. After discharge, anti-TNF therapy reduces abscess recurrence risk in a similar way to bowel resection.
摘要：
背景：腹内脓肿并发克罗恩病[CD]是一个具有挑战性的情况。他们的管理,住院期间和解决后，还不清楚。
方法：成人CD合并腹内脓肿患者。需要住院治疗的人，纳入GETECCU前瞻性维护的ENEIDA注册表。评估解决脓肿的初始策略有效性和安全性。进行生存分析以评估复发风险。通过多变量回归评估与消退相关的预测因素，并通过Cox回归评估与复发相关的预测因素。
结果：总而言之，来自37家西班牙医院的520名患者被纳入其中；322名[63%]最初仅使用抗生素治疗，128[26%]经皮引流，和54[17%]手术引流。脓肿的大小对每种治疗的有效性至关重要。在<30mm的脓肿中，抗生素与经皮或手术引流一样有效。然而,在较大的脓肿中，经皮或手术引流效果更佳。在>50毫米的脓肿中，手术优于经皮引流，尽管它与较高的并发症发生率相关。脓肿消退后，管腔切除与脓肿1年复发风险较低相关[HR0.43,95%CI0.24-0.76].然而,那些开始抗TNF治疗的患者,无论是否进行了腔内切除术,其复发风险相似.
结论：小脓肿[<30mm]可以单独使用抗生素治疗；较大的脓肿需要引流。在许多情况下，经皮引流比手术有效且安全。放电后,抗TNF治疗降低脓肿复发风险的方式与肠切除术相似.
方法：成人CD合并腹内脓肿患者。需要住院治疗的人，纳入GETECCU前瞻性维护的ENEIDA注册表。评估解决脓肿的初始策略有效性和安全性。进行生存分析以评估复发风险。通过多变量回归评估与消退相关的预测因素，并通过Cox回归评估与复发相关的预测因素。
结果：总而言之，来自37家西班牙医院的520名患者被纳入其中；322名[63%]最初仅使用抗生素治疗，128[26%]经皮引流，和54[17%]手术引流。脓肿的大小对每种治疗的有效性至关重要。在<30mm的脓肿中，抗生素与经皮或手术引流一样有效。然而,在较大的脓肿中，经皮或手术引流效果更佳。在>50毫米的脓肿中，手术优于经皮引流，尽管它与较高的并发症发生率相关。脓肿消退后，管腔切除与脓肿1年复发风险较低相关[HR0.43,95%CI0.24-0.76].然而,那些开始抗TNF治疗的患者,无论是否进行了腔内切除术,其复发风险相似.
结论：小脓肿[<30mm]可以单独使用抗生素治疗；较大的脓肿需要引流。在许多情况下，经皮引流比手术有效且安全。放电后,抗TNF治疗降低脓肿复发风险的方式与肠切除术相似.
