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对于克罗恩病,以暂时性静脉切除为治疗的方法:与原发性静脉切除相比,它是否会影响长期的疾病复发?
Michael Goldenshluger1,2, Lior Segev1,2
1Department of General Surgery, The Chaim Sheba Medical Center, Ramat Gan, Israel.
ANZ journal of surgery
|September 19, 2024
概括
与克罗恩病的暂时静脉切除 (ICR) 进行的双阶段静脉切除 (ICR) 与单阶段ICR相比,不会改变长期复发率. 这种手术方法不会影响疾病复发,为患者提供类似的结果.
科学领域:
- 胃肠病学 胃肠病学
- 手术瘤学手术瘤学
- 炎症性肠道疾病研究研究
背景情况:
- 克罗恩氏病 (CD) 管理通常涉及大眼切除 (ICR).
- 手术方法包括一阶段的ICR或两阶段的方法,以暂时的结节切开术和随后的逆转.
- 这些不同的手术策略对长期疾病复发的影响尚未完全理解.
研究的目的:
- 为了比较克罗恩氏病患者中疾病复发的风险,他们接受了两阶段的ICR治疗,并进行了临时性静脉切开术,而不是一阶段的ICR治疗.
- 评估不同外科手术管理策略的长期结果,以对CD的眼切除进行评估.
主要方法:
- 在2010年至2022年期间接受CD选择性初级ICR的191名成年患者的回顾性审查.
- 患者被分为两组:两阶段ICR (2S-ICR) 暂时结肠静脉修复和一阶段ICR (1S-ICR).
- 评估的结果包括术后并发症,停留时间,再入院率以及长期内镜,临床和手术复发.
主要成果:
- 2S-ICR组 (40名患者) 与1S-ICR组 (151名患者) 相比,具有更高的并发症负担,更低的BMI,更高的ASA得分,以及更大的手术前TPN需求和更低的白蛋白水平.
- 术后并发症的发生率在两组之间相似 (47.5%与47.7%),但2S-ICR的住院时间更长,30天再入院率更高.
- 经过63个月的中位随访后,两组患者表现出可比的内镜,临床和手术复发率.
结论:
- 与一阶段的ICR方法相比,使用临时静脉切除术的两阶段ICR并没有显著改变长期克罗恩病复发率.
- 对于克罗恩病,在一阶段和两阶段ICR之间的选择似乎不会影响长期疾病复发的风险.
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