活动期复杂克罗恩病患者分期手术与一期确定性手术效果的比较

目的比较活动期复杂克罗恩病（CD）患者采用损伤控制理念进行分期手术与一期确定性手术治疗效果的差别。方法回顾性分析2006年2月至2010年9月接受手术治疗的33例活动期复杂CD患者的临床资料。结果本组患者有14例行一期手术，19例分期手术。一期手术组与分期手术组术后并发症发生率分别为71％（10／14）和26％（5／19），两组比较，差异有统计学意义（P=0．015）。术后3个月内，两组患者早期临床复发率分别为36％（5／14）和0，两组比较，差异有统计学意义（P=0．008）：术后分期手术组临床和内镜下累计无复发率明显优于一期手术组（分别为P=0．000和P=0．006）。结论活动期复杂CD采用损伤控制理念进行分期手术，可以降低术后并发症发生率和术后复发率。

Comparison between staged surgery and one-stage surgery in active complex Crohn disease

Objective To compare the prognosis between staged surgery and one-stage surgery in active complex Crohn disease (CD). Methods Clinical data of 33 patients with active complex CD from February 2006 to September 2010 were analyzed retrospectively. Inclusion criteria:Patients who were diagnosed with CD by pathology or endoscopy with CD activity index (CDAI) ＞220 and long history of preoperative steroid use(over 6 months), or complicated with severe preoperative malnutrition.The indications for surgery included enterocutaneous or enteroenteric fistula, with/without intraabdominal abscess, intestinal obstruction, and acute intestinal perforation intra-abdominal sepsis. The surgical procedures, including staged surgery and one-stage definite surgery were chosen by experienced surgeons. All the patients quited smoking and received immunosuppressant therapy (TwHF or azathioprine) together with enteral nutrition supplement for preventing postoperative recurrence. All the patients were followed up after the surgery with regards to CDAI, serum C-reactive protein (CRP),erythrocyte sedimentation rate (ESR). Postoperative complications, clinical and endoscopic recurrence were recorded. Results Of the 33 patients, 14 underwent one-stage definite surgery and 19 received staged surgery. Postoperative complication rates in the two groups were 71% and 26% respectively (P=0.015). The early clinical recurrence rates within postoperative 3 months were 36% and 0(P=0.008). In regard to cumulative probability of post-operative dinical and endoscopic recurrence, staged surgery group was superior to one stage definite surgery group (P=0.000 and 0.006). Conclusion Staged surgery may significantly increase the success rate of operation, reduce postoperative complications and postoperative early relapse, and decrease postoperative recurrence.