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Clin Gastroenterology H:回盲部切除术后内镜下缓解患者克罗恩病术后晚期复发的风险分析

2021-06-13 MedSci原创 MedSci原创

克罗恩病(CD)是一种慢性致残性炎症性肠病(IBD),大约一半的病人在确诊后的头十年需要手术治疗,三分之一的患者在病程中需要多次进行肠切除手术。

      克罗恩病(CD)是一种慢性致残性炎症性肠病(IBD),大约一半的病人在确诊后的头十年需要手术治疗,三分之一的患者在病程中需要多次进行肠切除手术。Rutgeerts评分可以对回盲部切除术后内镜下CD复发症状的严重程度进行分级,从而判断内镜下疾病复发情况。一般来说,Rutgeerts评分i0(无内窥镜病变)或i1(新末端回肠1至5处阿弗他病变)反映内窥镜病情缓解,但是早期内窥镜病情缓解并不排除长期疾病并不会复发。因此,本项研究对克罗恩病(CD)术后1-10年复发的风险进行了相关研究。

 

       研究人员在法国和比利时的3个炎症性肠病(IBD)中心进行了一项回顾性研究,试验进行的时间从2006年开始到2016年结束,所有CD患者(n=86)都接受了回盲部切除术,在基线评估时没有内窥镜证据显示疾病存在复发(Rutgeerts评分低于i2)。基线内窥镜检查后的术后复发被定义为至少达到以下1项:临床复发、IBD相关的住院治疗、肠损伤的发生、需要内窥镜行球囊扩张吻合口以及需要重复手术治疗。

 

      手术和基线内镜检查之间的中位时间为7个月(IQR,5.7-9.5个月);40例(46.5%)在此期间接受了药物预防。35名患者(40.7%)出现术后晚期复发,基线内镜检查后疾病复发的中位时间为14.2个月(IQR,6.3–26.1个月)。在基线检查时,Rutgeerts评分为i0(20/55)或i1(15/31)的患者的复发状态没有显著差异(P=0.28),并且与药物预防无关(预防性治疗组16/40,未预防性治疗组19/46;P=0.90)。同时,71例患者中有29例(40.8%)存在粘膜损伤病变进展。

图:回盲部切除术后内镜下缓解患者克罗恩病术后晚期复发的表现

      本项研究发现在回盲部切除术治疗的CD患者中,40%的患者在中位随访时间为3.5年后出现晚期复发,尽管最初的有内镜下缓解,但仍建议在18个月后对这些患者进行严密疾病活动度监测。

 

 

原始出处:

Lieven Pouillon. Et al. Risk of Late Postoperative Recurrence of Crohn’s Disease in Patients in Endoscopic Remission After Ileocecal Resection, Over 10 Years at Multiple Centers. Clinical Gastroenterology and Hepatology.2021.

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    2021-11-24 许安
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    2021-06-13 sallylee_87

    不错,学习了

    0

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