中华消化外科杂志
中華消化外科雜誌
중화소화외과잡지
CHINESE JOURNAL OF DIGESTIVE SURGERY
2014年
8期
607-611
,共5页
杨晓旭%于健春%康维明%朱长真%马志强%叶欣
楊曉旭%于健春%康維明%硃長真%馬誌彊%葉訢
양효욱%우건춘%강유명%주장진%마지강%협흔
克罗恩病%再次手术%危险因素
剋囉恩病%再次手術%危險因素
극라은병%재차수술%위험인소
Crohn's disease%Reoperation%Risk factor
目的 探讨克罗恩病术后复发行再次手术的危险因素.方法 回顾性分析2004年3月至2013年9月中国医学科学院北京协和医院收治的108例克罗恩病行肠切除术患者的临床资料.其中82例患者行单次手术,26例行再次手术.分析可能影响克罗恩病患者术后复发行再次手术的25项因素,包括患者性别、年龄、血型、术前WBC、术前中性粒细胞、术前淋巴细胞、术前Hb、术前Alb、术前前白蛋白、超敏C-反应蛋白(hs-CRP)水平、抗酿酒酵母抗体(ASCA)表达、中性粒细胞胞质抗体(ANCA)表达、病变原发部位、疾病类型、肠外表现、肛周病变、吸烟史、阑尾手术史、初次手术前病程、初次手术前1年内使用免疫抑制剂、初次手术前BMI、术前小野寺预后营养指数(OPNI)、初次手术前应用肠内营养、是否急诊手术、初次术后并发症情况.单因素分析采用x2检验或Fisher确切概率法,多因素分析采用Logistic回归模型.结果 单因素分析结果表明:术前前白蛋白、hs-CRP、病变原发部位、疾病类型、吸烟史、初次手术前1年内使用免疫抑制剂及初次手术前应用肠内营养是克罗恩病患者术后复发行再次手术的危险因素(x2=5.928,4.805,7.491,12.363,5.229,9.026,16.506,P＜0.05).多因素分析结果表明:病变原发部位为回结肠型(L3型)、初次手术前1年内使用免疫抑制剂及初次手术前应用肠内营养制剂提供热量＜500 kcal/d是克罗恩病患者术后复发行再次手术治疗的独立危险因素(OR=1.908,3.535,5.489,95％可信区间:1.035～3.518,1.087 ～ 11.494,1.816 ～ 16.590,P＜0.05).结论 克罗恩病病变部位为回结肠型(L3型)、初次手术前1年内行免疫抑制剂治疗及初次手术前2周内每日肠内营养制剂提供热量＜ 500 kcal的患者有较高的复发再次手术风险.
目的 探討剋囉恩病術後複髮行再次手術的危險因素.方法 迴顧性分析2004年3月至2013年9月中國醫學科學院北京協和醫院收治的108例剋囉恩病行腸切除術患者的臨床資料.其中82例患者行單次手術,26例行再次手術.分析可能影響剋囉恩病患者術後複髮行再次手術的25項因素,包括患者性彆、年齡、血型、術前WBC、術前中性粒細胞、術前淋巴細胞、術前Hb、術前Alb、術前前白蛋白、超敏C-反應蛋白(hs-CRP)水平、抗釀酒酵母抗體(ASCA)錶達、中性粒細胞胞質抗體(ANCA)錶達、病變原髮部位、疾病類型、腸外錶現、肛週病變、吸煙史、闌尾手術史、初次手術前病程、初次手術前1年內使用免疫抑製劑、初次手術前BMI、術前小野寺預後營養指數(OPNI)、初次手術前應用腸內營養、是否急診手術、初次術後併髮癥情況.單因素分析採用x2檢驗或Fisher確切概率法,多因素分析採用Logistic迴歸模型.結果 單因素分析結果錶明:術前前白蛋白、hs-CRP、病變原髮部位、疾病類型、吸煙史、初次手術前1年內使用免疫抑製劑及初次手術前應用腸內營養是剋囉恩病患者術後複髮行再次手術的危險因素(x2=5.928,4.805,7.491,12.363,5.229,9.026,16.506,P＜0.05).多因素分析結果錶明:病變原髮部位為迴結腸型(L3型)、初次手術前1年內使用免疫抑製劑及初次手術前應用腸內營養製劑提供熱量＜500 kcal/d是剋囉恩病患者術後複髮行再次手術治療的獨立危險因素(OR=1.908,3.535,5.489,95％可信區間:1.035～3.518,1.087 ～ 11.494,1.816 ～ 16.590,P＜0.05).結論 剋囉恩病病變部位為迴結腸型(L3型)、初次手術前1年內行免疫抑製劑治療及初次手術前2週內每日腸內營養製劑提供熱量＜ 500 kcal的患者有較高的複髮再次手術風險.
목적 탐토극라은병술후복발행재차수술적위험인소.방법 회고성분석2004년3월지2013년9월중국의학과학원북경협화의원수치적108례극라은병행장절제술환자적림상자료.기중82례환자행단차수술,26례행재차수술.분석가능영향극라은병환자술후복발행재차수술적25항인소,포괄환자성별、년령、혈형、술전WBC、술전중성립세포、술전림파세포、술전Hb、술전Alb、술전전백단백、초민C-반응단백(hs-CRP)수평、항양주효모항체(ASCA)표체、중성립세포포질항체(ANCA)표체、병변원발부위、질병류형、장외표현、항주병변、흡연사、란미수술사、초차수술전병정、초차수술전1년내사용면역억제제、초차수술전BMI、술전소야사예후영양지수(OPNI)、초차수술전응용장내영양、시부급진수술、초차술후병발증정황.단인소분석채용x2검험혹Fisher학절개솔법,다인소분석채용Logistic회귀모형.결과 단인소분석결과표명:술전전백단백、hs-CRP、병변원발부위、질병류형、흡연사、초차수술전1년내사용면역억제제급초차수술전응용장내영양시극라은병환자술후복발행재차수술적위험인소(x2=5.928,4.805,7.491,12.363,5.229,9.026,16.506,P＜0.05).다인소분석결과표명:병변원발부위위회결장형(L3형)、초차수술전1년내사용면역억제제급초차수술전응용장내영양제제제공열량＜500 kcal/d시극라은병환자술후복발행재차수술치료적독립위험인소(OR=1.908,3.535,5.489,95％가신구간:1.035～3.518,1.087 ～ 11.494,1.816 ～ 16.590,P＜0.05).결론 극라은병병변부위위회결장형(L3형)、초차수술전1년내행면역억제제치료급초차수술전2주내매일장내영양제제제공열량＜ 500 kcal적환자유교고적복발재차수술풍험.
Objective To investigate the risk factors of reoperation in patients with Crohn's disease recurrence.Methods The clinical data of 108 patients with Crohn's disease who were admitted to the Peking Union Medical College Hospital from March 2004 to September 2013 were retrospectively analyzed.Of the 108 patients,82 received single operation and 26 received reoperation.Twenty-five factors which might influence the reoperation were analyzed,which were gender,age,blood type,preoperative levels of white blood cells,neutrophils,lymphocytes hemoglobin,albumin,prealbumin,high sensitive-C reactive protein (hs-CRP),anti-saccharomyces cerevisiae antibody (ASCA),anti-neutrophil cytoplasmic antibody (ANCA),location and type of the lesions,extraintestinal manifestation,perianal lesions,history of smoking,appendectomy,course of the disease before the first operation,pre-operative administration of immunosuppressants,body mass index (BMI) before the first operation,onodera prognostic nutrition index (OPNI),enteral nutrition,emergent operation,complications after the first operation.The univariate analysis was done using the chi-square test or Fisher exact probability,and the multivariate analysis was done using the Logistic regression model.Results The results of univariate analysis showed that the level of preoperative prealbumin,hs-CRP,location and type of the lesion,the history of smoking,preoperative administration of immunosuppressants,enteral nutrition before the first operation were the risk factors of reoperation in patients with Crohn's disease (x2=5.928,4.805,7.491,12.363,5.229,9.026,16.506,P ＜ 0.05).The results of multivariate analysis showed that the lesion located at the ileocolon,administration of immunosuppressants prior to the first operation for 1 year and energy provided by enteral nutrition under 500 kcal/d before the first operation were the independent risk factors of reoperation (OR =1.908,3.535,5.489,95％ confidence interval:1.035-3.518,1.087-11.494,1.816-16.590,P＜0.05).Conclusions Patients with lesions located at the ileocolon,administration of immunosuppresants prior to the first operation for 1 year and energy provided by enteral nutrition under 500 kcal before the first operation have higher risk of Crohn's disease recurrence and reoperation.
