克罗恩病初次手术与术后并发症的危险因素分析  

Risk factors analysis of initial surgery and postoperative complications of Crohn＇s disease

作　　者：刘桂伟[1] 刘艳华[1] 姜国胜[1] 任维聃[1] 

机构地区：[1]河北省沧州市中心医院肛肠外科,061000

出　　处：《中华消化外科杂志》2016年第12期1150-1155,共6页Chinese Journal of Digestive Surgery

摘　　要：目的分析克罗恩病的初次手术与术后并发症的危险因素。方法采用回顾性病例对照研究方法。收集2011年4月至2015年7月河北省沧州市中心医院收治的227例克罗恩病患者的临床资料。治疗原则为：患者临床症状减轻、内镜下肠黏膜出现愈合、延缓病情进展、预防肠衰竭及相关并发症的发生。早期给予药物治疗；若药物控制不佳，或合并肠梗阻、肠瘘、消化道穿孔、腹腔脓肿、复杂肛瘘等合并症，则施行部分肠段切除术。观察指标：（1）治疗情况。（2）随访情况。（3）影响克罗恩病患者初次行手术治疗的相关因素分析。（4）影响初次行手术治疗的克罗恩病患者发生术后并发症的相关因素分析。采用电话和门诊方式对手术患者进行随访，随访内容为患者术后并发症发生情况，包括切口感染、腹腔脓肿、肠梗阻、吻合口瘘、肺部感染。随访时间截至2016年5月。正态分布的计量资料以面±S表示，组间比较采用t检验；计数资料以百分数表示，采用∥检验。单因素分析采用，和非参数秩和检验，多因素分析采用Logistic回归模型。结果（1）治疗情况：227例克罗恩病患者中，68例初次行手术治疗，159例采用非手术治疗。68例初次行手术治疗患者疾病确诊至初次手术间隔时间为（4．7±2．5）个月，其中28例行急诊手术治疗，40例行择期手术治疗；手术时间为（175±44）min；术中出血量为（285±110）mL；吻合方式：侧侧吻合47例，非侧侧吻合21例。159例非手术治疗患者，采用美沙拉嗪、氢化可的松、甲氨蝶呤、英夫利昔单抗克隆抗体治疗。（2）随访情况：68例初次行手术治疗患者均获得随访，随访时间为5—61个月。68例初次行手术治疗的克罗恩病患者中，术后22例发生并发症。9例患者发生吻合口瘘，其中6例为肠外瘘（5例择期手术治疗好转，1例进展为急�Objective To explore the risk factors of initial surgery and postoperative complications of Crohn＇s disease （CD）. Methods The retrospective ease-control study was conducted. The clinical data of 227 patients with CD who were admitted to the Cangzhou Central Hospital from April 2011 to July 2015 were collected. Treatment principles included reducing the clinical symptoms, promoting healing of intestinal mucosa under endoscopy, delaying CD progression and preventing intestinal exhaustion and related complications. The medication was performed in the early period. The resection of partial intestines was applied to patients if there was poor effect of medication or combined with intestinal obstruction, intestinal fistula, digestive tract perforation, abdominal abscess and complex anal fistula. Observation indicators： （1） treatment situation, （2） follow-up situation, （3） related factors analysis affecting initial surgery of patients with CD, （4） related factors analysis affecting postoperative complications of patients after initial surgery for CD. Follow-up using regular telephone interview and outpatient examination was performed up to May 2016. Follow-up included the wound infection, abdominal abscess, intestinal obstruction, anastomotic fistula and pulmonary infection. Measurement data with normal distribution were represented as ~ ＋ s and comparison between groups was analyzed using the t test. Count data were represented as the proportion and analyzed by the chi-square test. The univariate analysis was done using the chi-square test and Kruskal-Wallis test, and multivariate analysis was done using the Logistic regression model. Results （1） Treatment situation： of 227 patients, 68 underwent initial surgery and 159 didn＇t undergo surgery. The duration from diagnosis to initial surgery in 68 patients was （4.7 ± 2.5 ） months. Of 68 patients with surgery, 28 received the emergency surgery and 40 received the selective surgery. Operation time and volume of intraoperative blood lo

关 键 词：克罗恩病 外科手术 并发症 危险因素 

分 类 号：R656[医药卫生—外科学]