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治疗IBD手术后的无治疗结果:全国范围的队列研究
Adam S Faye1, Jordan Axelrad1, Jiangwei Sun2
1Division of Gastroenterology, Department of Medicine, NYU School of Medicine, Inflammatory Bowel Disease Center at NYU Langone Health, New York, New York, USA.
手术可以消除对未来治疗的需要,在炎症性肠病患者的很大一部分. 诸如疾病持续时间和肠外表现的不存在等因素影响克罗恩病和性结肠炎手术后的长期结果.
科学领域:
- 胃肠病学 胃肠病学
- 外科胃肠道外科手术
- 临床流行病学 临床流行病学
背景情况:
- 炎症性肠病 (IBD) 管理通常涉及终身治疗.
- 对于某些IBD患者来说,手术可能是治愈的选择,可能会避免未来的治疗方法.
研究的目的:
- 为了确定在初始IBD手术后五年内保持无治疗的患者的特征.
- 为精密外科手术策略提供信息,以优化长期患者的益处.
主要方法:
- 全国范围的队列研究使用瑞典国家患者登记册和ESPRESSO组织病理学.
- 对为克罗恩病 (CD) 进行肠切除或为性结肠炎 (UC) 进行全肠切除的患者的分析 (2007-2018).
- 在手术后五年内需要IBD治疗的调整几率比率 (aORs) 的计算.
主要成果:
- 21.5%的CD患者和42.4%的UC患者在五年内仍然没有接受治疗.
- 在CD中较长的术前疾病持续时间和UC中较长的年龄与没有接受治疗有关.
- 在CD患者中,肠外表现 (CD aOR 0.64;UC aOR 0.48) 和COPD降低了没有治疗的可能性.
结论:
- 在22%的CD患者和42%的UC患者中,手术成功避免了进一步的治疗.
- 缺少肠外表现,年龄较大 (UC),疾病持续时间较长 (CD) 和缺少COPD (CD) 是成功的长期手术结果的关键指标.
- 精确手术可以确定IBD患者最有可能从外科手术中长期受益.
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