A. Vardanyan, M. Shapina, A. V. Poletova, S. Achkasov
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引用次数: 1
摘要
目的:提高克罗恩病的手术治疗效果。患者和方法:纳入162例患者。69例(42.6%)患者术前接受保守治疗。回肠盲肠切除术148例(91.4%),回肠部分切除术5例(3.1%),半结肠切除术6例(3.7%)。造口104例(64.2%)。并发症25例(15.4%)。结果:在单变量分析中发现,年龄在40岁以下、男性和手术时间短(150 min)是无并发症术后期(分别降低10、5、10倍风险)的预测因素(分别为0.03、0.03、0.02)。术前未接受保守治疗的患者并发症发生率比接受治疗的患者增加3倍以上(OR 3,2 CI 95% 0,1 - 11,45;(r = 0,06),但我们未能获得显著性,因此我们进行了多变量分析,以了解所有临床因素对未治疗患者的影响。所有模型均有统计学意义。结论:男性(OR 0,2 CI 95% 0,01 - 2,02;年龄小于40岁(OR 0,1 CI 95% 0,02 - 0,9;r = 0,03),手术时间小于150分钟(OR 0,1 CI 95% 0,01 - 2,02;(r = 0,03)与术后并发症的减少有关。术前3个月的保守治疗可将并发症发生率降低至3,5次(OR 3,5 CI 95% 1,2 - 9,8;(χ2 = 7,56;= 0.006)。
Risk factors for postoperative complications after surgery in complicated Crohn’s disease
Aim: to improve results of the surgical treatment of Crohn’s disease. Patients and Methods: 162 patients were included. 69 (42,6 %) — received preoperative conservative treatment. Ileocecal resection was performed in 148 (91,4 %), in 5 (3,1 %) cases — part of jejunum resection, ileum resection — in 3 (1,8 %) patients and right hemicolectomy — 6 (3,7 %). Stoma formation was in 104 (64,2 %) patients. Complications were registered in 25 (15,4 %) cases. Results: in univariant analysis it was found that young age up to 40 years, male gender and short operative time ( 150 min) are the predictors (р = 0,03, р = 0,03 и р = 0,02, respectively) to noncomplicated postoperative period (reduce risk in 10, 5 и 10 fold, respectively). The absence of conservative treatment before surgery increased the complications’ rate more than 3 times comparing to patients who received therapy (OR 3,2 CI 95 % 0,1–11,45; р = 0,06), but we failed to get significance, that is why multivariant analysis was carried out to see the influence of all clinical factors on non-treated patients. Significance was found in all models. Conclusion: male gender (OR 0,2 CI 95 % 0,01–2,02; р = 0,02), the age younger than 40 (OR 0,1 CI 95 % 0,02–0,9; р = 0,03) and the duration of the operation less than 150 minutes (OR 0,1 CI 95 % 0,01–2,02; р = 0,03) is associated with the reduction of complications in the postoperative period. Preoperative conservative treatment during 3 months allows to decrease the rate of complications to 3,5 times (OR 3,5 CI 95 % 1,2–9,8; р = 0,01) and risk of the stoma formation — to 7 times (χ2 = 7,56; р = 0,006).