反复手术治疗复发并不是克罗恩病患者行腹腔镜回结肠切除术的危险因素

IF 2.7 2区医学 Q1 SURGERY

Surgery Pub Date : 2025-06-02 DOI:10.1016/j.surg.2025.109456

Federico Ghignone MD , Giovanni Taffurelli MD, PhD , Federica Greco MD , Davide Zattoni MD , Isacco Montroni MD, PhD , Giampaolo Ugolini MD, PhD

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引用次数: 0

摘要

背景：因克罗恩病接受回肠结肠切除术的患者由于复发有重复手术的风险。微创入路在复发病例中存在争议。本研究旨在确定转换为开放手术的预测因素，并探讨重复腹腔镜手术是否代表转换的危险因素。复发与初次手术的结果也进行了评估。方法这是一项回顾性单中心队列研究，纳入2017年1月至2023年12月期间接受腹腔镜手术治疗原发性和复发性回肠结肠克罗恩病的所有患者。根据最小绝对收缩和选择操作者进行单因素和多因素分析，以确定与转换为开放手术和术后结果相关的因素。结果共纳入202例患者；平均年龄为49岁。半数患者营养不良，术前接受类固醇/生物制剂治疗。120例（59.4%）患者因狭窄性疾病接受手术治疗。大多数人在美国麻醉医师协会的评分为1或2分。134例患者行回肠结肠切除术，68例（33.6%）因复发而行手术。转化率为10.3%（21/202）。平均住院时间为5.2天。严重并发症8例（3.9%），吻合口漏率3.4%。多变量分析显示，只有美国麻醉医师学会评分是转换的危险因素。原发和复发回肠结肠切除术在转移造口、并发症、再手术、住院时间和再入院方面无统计学差异。结论既往克罗恩病手术与转化风险无关；术后结果与原发回结肠切除术无显著差异。对于复发性克罗恩病患者，应尝试微创入路。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

Repeated surgery for recurrence is not a risk factor for conversion in patients undergoing laparoscopic ileo-colonic resection for Crohn disease

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Repeated surgery for recurrence is not a risk factor for conversion in patients undergoing laparoscopic ileo-colonic resection for Crohn disease

Background

Patients who undergo ileo-colonic resection for Crohn disease are at risk of repeated surgery because of recurrence. Minimally invasive approach is debated in recurrent cases. This study aims to identify predictors for conversion to open surgery and explore if a repeated laparoscopic procedure represents a risk factor for conversion. Outcomes of recurrent versus primary surgery were also evaluated.

Methods

This is retrospective single-center cohort study enrolling all patients undergoing laparoscopic surgery for primary and recurrent ileo-colic Crohn disease between January 2017 and December 2023. Univariate and multivariate analysis according to the least absolute shrinkage and selection operator were carried out to identify factors associated with conversion to open surgery and postoperative outcomes.

Results

A total of 202 patients were included; the mean age was 49 years. Half were malnourished and received steroids/biologics before surgery. One hundred twenty patients (59.4%) underwent surgery for stenosing disease. Most had American Society of Anesthesiologists score 1 or 2. One hundred thirty-four patients underwent primary ileo-colonic resection and 68 (33.6%) were operated for recurrence. Conversion rate was 10.3% (21/202). Mean length of stay was 5.2 days. Eight patients (3.9%) had severe complications, and anastomotic leak rate was 3.4%. Multivariate analysis showed that only American Society of Anesthesiologists score was a risk factor for conversion. No statistically significant differences were noted in terms of diverting stoma, complications, reoperation, length of stay, and readmission between primary and recurrent ileo-colonic resection.

Conclusions

Previous surgery for Crohn disease is not correlated with the risk of conversion; postoperative outcomes are not significantly different from those for primary ileo-colonic resection. Minimally invasive approach should be attempted in every patient undergoing surgery for recurrent Crohn disease.

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来源期刊

Surgery 医学-外科

CiteScore

5.40

自引率

5.30%

发文量

687

审稿时长

64 days

期刊介绍： For 66 years, Surgery has published practical, authoritative information about procedures, clinical advances, and major trends shaping general surgery. Each issue features original scientific contributions and clinical reports. Peer-reviewed articles cover topics in oncology, trauma, gastrointestinal, vascular, and transplantation surgery. The journal also publishes papers from the meetings of its sponsoring societies, the Society of University Surgeons, the Central Surgical Association, and the American Association of Endocrine Surgeons.