背景:作者注释:TY,AS,YS,FVT和PGK设计了这项研究。所有作者都进行了数据收集,并为研究设计和讨论做出了科学贡献。TY,AS和PGK起草了该文章。所有作者都阅读并批准了手稿的最终版本。在生物制剂时代,克罗恩病切除术后并发症的危险因素尚未完全确定.特别是,术前使用免疫抑制剂和生物制剂与切除术后并发症发生率之间的关系尚待阐明.
目的:这项回顾性多中心研究旨在确定克罗恩病回肠结肠切除术后并发症的危险因素,主要关注术前免疫抑制和生物治疗的影响。
方法:共有来自三个国家的七个炎症性肠病转诊中心的231名连续患者因活动性克罗恩病接受回结肠切除术(日本,包括巴西和意大利)。以下变量作为潜在风险因素进行了调查:手术年龄,性别,克罗恩病的行为(穿孔与非穿孔疾病),吸烟,术前(手术前八周内)使用类固醇,免疫抑制剂和生物制剂,先前的切除,输血,外科手术(开放式与腹腔镜入路),和吻合类型(侧对侧vs.端到端)。记录术后30天内发生的并发症。
结果:总体并发症的发生率,腹内脓毒症,吻合口漏占24%,12%和8%,分别。手术前的免疫抑制或生物治疗均与整体并发症的发生率显着相关。腹内脓毒症或吻合口漏。在多变量分析中,输血,穿孔疾病和既往切除是总体并发症的显著危险因素(比值比[OR]3.02,95%置信区间[CI]1.21-7.52;P=0.02),腹内脓毒症(OR2.67,95%CI1.04-6.86;P=0.04)和吻合口漏(OR2.87,95%CI1.01-8.18;P=0.048),分别。
结论:输血,穿孔疾病和先前的切除是整体并发症的重要危险因素,克罗恩病回肠结肠切除术后腹腔内败血症和吻合口漏,分别。术前免疫抑制或生物治疗未增加术后并发症的风险。
BACKGROUND: Author note: TY, AS, YS, FVT and PGK designed the
study. All authors did data collection and gave scientific contribution to the
study design and discussion. TY, AS and PGK drafted the article. All authors read and approved the final version of the manuscript.In the era of biologic agents, risk factors for complications following resection for Crohn\'s disease have not been fully identified. In particular, the association of preoperative use of immunosuppressive and biologic agents with the incidence of complications after resection remains to be elucidated.
OBJECTIVE: This retrospective multicentre
study aimed to identify risk factors for complications after ileocolonic resection for Crohn\'s disease, with a major focus on the impact of preoperative immunosuppressive and biologic therapy.
METHODS: A total of 231 consecutive patients who underwent ileocolonic resections for active Crohn\'s disease in seven inflammatory bowel disease referral centres from three countries (Japan, Brazil and Italy) were included. The following variables were investigated as potential risk factors: age at surgery, gender, behaviour of Crohn\'s disease (perforating vs. non-perforating disease), smoking, preoperative use (within eight weeks before surgery) of steroids, immunosuppressants and biologic agents, previous resection, blood transfusion, surgical procedure (open vs. laparoscopic approach), and type of anastomosis (side-to-side vs. end-to-end). Postoperative complications occurring within 30 days after surgery were recorded.
RESULTS: The rates of overall complications, intra-abdominal sepsis, and anastomotic leak were 24%, 12% and 8%, respectively. Neither immunosuppressive nor biologic therapy prior to surgery was significantly associated with the incidence of overall complications, intra-abdominal sepsis or anastomotic leak. In multivariate analysis, blood transfusion, perforating disease and previous resection were significant risk factors for overall complications (odds ratio [OR] 3.02, 95% confidence interval [CI] 1.21-7.52; P = 0.02), intra-abdominal sepsis (OR 2.67, 95% CI 1.04-6.86; P = 0.04) and anastomotic leak (OR 2.87, 95% CI 1.01-8.18; P = 0.048), respectively.
CONCLUSIONS: Blood transfusion, perforating disease and previous resection were significant risk factors for overall complications, intra-abdominal sepsis and anastomotic leak after ileocolonic resection for Crohn\'s disease, respectively. Preoperative immunosuppressive or biologic therapy did not increase the risk of postoperative complications.