既往肠切除对克罗恩病患者肠切除吻合术后吻合口瘘的影响  

Effect of previous intestinal resection on postoperative anastomotic fistula in Crohn's disease with intestinal resection and anastomosis

作　　者：段衍涛 黄雨桦 刘斌[1] 姚丹华 郑磊[1] 周致圆[1] 王鹏飞 李幼生[1] Duan Yantao;Huang Yuhua;Liu Bin;Yao Danhua;Zheng Lei;Zhou Zhiyuan;Wang Pengfei;Li Yousheng(Department of General Surgery,Shanghai Ninth People's Hospital,Shanghai Jiaotong University School of Medicine,Shanghai 200011,China)

机构地区：[1]上海交通大学医学院附属第九人民医院普外科,200011

出　　处：《中华普通外科杂志》2020年第8期620-623,共4页Chinese Journal of General Surgery

基　　金：国家自然科学基金(81802303);白求恩·爱惜康卓越外科基金(HZB-20181119-9);上海交通大学医学院附属第九人民医院临床研究助力计划(JYIJ022);上海交通大学医学院附属第九人民医院临床研究型MDT项目(201701008);浦东新区卫生和计划生育委员会卫生计生科研项目(PW2018D4M)。

摘　　要：目的 分析既往肠切除对克罗恩病患者肠切除吻合术后30d内吻合口瘘的影响.方法 回顾性分析2016年1月到2019年9月在上海交通大学医学院附属第九人民医院行肠切除吻合术的92例克罗恩病患者的临床资料,分为无既往肠切除组(45例)和既往肠切除组(47例),分析既往肠切除与克罗恩病患者肠切除吻合术后吻合口瘘的关系.结果 92例克罗恩病患者术后共11例(12%)患者发生吻合口瘘,其中无既往肠切除组2例,既往肠切除组9例,两组差异有统计学意义(x^2=4.722,P=0.03).既往肠切除组与无既往肠切除组吻合口瘘发生率OR值为5.092(95% CI:1.035~25.048).既往1次肠切除(24例)患者吻合口瘘发生率为13%,既往>1次肠切除(23例)患者吻合口瘘发生率为26%.既往肠切除次数增多与术后吻合口瘘发生风险增高相关(r=0.995).结论 既往肠切除是克罗恩病患者肠切除吻合术后吻合口瘘发生的危险因素.Objective To explore the effect of previous intestinal resection on anastomotic fistula within 30 days after surgery in Crohn's disease.Methods The clinical data from 92 Crohn's disease patients who underwent intestinal resection and anastomosis at the Department of General Surgery in Shanghai Ninth People's Hospital,Shanghai Jiaotong University School of Medicine from Jan 2016 to Sep 2019.Patients were divided into no previous intestinal resection group(n=45)and previous intestinal resection group(n=47).The relationship between previous intestinal resection and postoperative anastomotic leak in Crohn's disease patients with intestinal resection and anastomosis was analyzed.Results A total of 11 cases(12%leak rate)underwent postoperative anastomotic leak.There were 2 leaks in patients with no previous history of intestinal resection,while 9 leaks in patients with previous bowel resection(x^2=4,722,P=0.03).The OR of the postoperative anastomotic leak in Crohn's disease patients with previous intestinal resection compared with no previous intestinal resection group was 5.092(95%CI:1.035-25.048).Patients with 1 previous resection(24 cases)had a leak rate of 13%,whereas patients with>1 previous resection episodes(23 cases)had a leak rate of 26%.The number of previous resection episodes correlated with an increasing risk for clinical anastomotic leak(correlation coefficien r=0.995).Conclusions Previous intestinal resection is an independent risk factor for ensuing postoperative anastomotic leak in Crohn's disease patients with intestinal resection and anastomosis.

关 键 词：CROHN病 吻合口瘘 吻合术 外科 危险因素 

分 类 号：R656.9[医药卫生—外科学]