CAJ | 학술논문

目的探讨影响克罗恩病(CD)患者肠切除术后吻合口感染性并发症发生的危险因素.方法回顾性分析1990年1月至2012年10月间在浙江省丽水市人民医院接受肠切除手术的114例CD患者的临床资料,分别通过x2检验和Logistic回归模型对术后发生吻合口感染性并发症的发生风险进行单因素和多因素分析.结果术后吻合口感染性并发症发生率为12.3％(14/114),其中吻合口瘘7例,腹腔脓肿6例,肠外瘘1例.多因素分析显示,克罗恩病活动指数(CDAI)大于150(OR=2.185,95％CI:1.098～6.256)、术前使用甾体类药物(OR=2.674,95％CI:1.118～8.786)及合并腹腔脓肿和(或)瘘(OR=3.447,95％CI:1.254～10.462)是术后出现吻合口感染性并发症的独立高危因素(均P＜0.05).无上述危险因素者术后吻合口感染性并发症发生率为5.7％(3/53),有1个危险因素者为11.4％(4/35),2个危险因素者21.1％(4/19),3个危险因素者则可高达42.9％(3/7).结论术前使用甾体类药物、CDAI大于150及合并腹腔脓肿和(或)瘘是CD肠切除术后出现吻合口感染性并发症的高危因素.如果这些危险因素术前无法消除,肠切除术后行一期吻合应持谨慎态度.
목적 탐토영향극라은병(CD)환자장절제술후문합구감염성병발증발생적위험인소.방법 회고성분석1990년1월지2012년10월간재절강성려수시인민의원접수장절제수술적114례CD환자적림상자료,분별통과x2검험화Logistic회귀모형대술후발생문합구감염성병발증적발생풍험진행단인소화다인소분석.결과 술후문합구감염성병발증발생솔위12.3％(14/114),기중문합구루7례,복강농종6례,장외루1례.다인소분석현시,극라은병활동지수(CDAI)대우150(OR=2.185,95％CI:1.098～6.256)、술전사용치체류약물(OR=2.674,95％CI:1.118～8.786)급합병복강농종화(혹)루(OR=3.447,95％CI:1.254～10.462)시술후출현문합구감염성병발증적독립고위인소(균P＜0.05).무상술위험인소자술후문합구감염성병발증발생솔위5.7％(3/53),유1개위험인소자위11.4％(4/35),2개위험인소자21.1％(4/19),3개위험인소자칙가고체42.9％(3/7).결론 술전사용치체류약물、CDAI대우150급합병복강농종화(혹)루시CD장절제술후출현문합구감염성병발증적고위인소.여과저사위험인소술전무법소제,장절제술후행일기문합응지근신태도.
Objective To investigate the risk factors for anastomotic infectious complications after bowel resection in patients with Crohn disease.Methods Clinical data of 124 patients with Crohn disease undergoing bowel resection between January 1990 and October 2012 were analyzed retrospectively.The risk factors were identified by x2 test and Logistic regression.Results Fourteen patients (12.3％,14/114) developed anastomotic infectious complications in the postoperative period,including anastomotic leak (n=7),intra-abdominal abscess(n=6),and enterocutaneous fistula (n=1).Crohn disease activity index (CDAI)＞150 (OR=2.185,95％CI:1.098-6.256,P=0.040),steroid usage (OR=2.674,95％CI:1.118-8.786,P=0.027),and the presence of preoperative abscess/fistula (OR=3.447,95％ CI:1.254-10.462,P=0.014) were identified as independent risk factors of anastomotic infectious complications.In the absence of these 3 risk factors,the rate of anastomotic infectious complication was 5.7％ (3/53),which increased to 11.4％ (4/35) when one risk factor was present,21.1％(4/19) when two risk factors were present,and 42.9％(3/7) when all the 3 risk factors were present.Conclusions CDAI＞150,steroid usage and preoperative abscess/fistula are associated with higher rates of anastomotic infectious complications following bowel resection for Crohn disease.A prudent management should be carried out if risk factors can not be eliminated preoperatively.