Objective: To analyze the cumulative reoperation rate of postoperative Crohn's disease (CD) patients and investigate the operation reasons and the effects of drugs on surgical recurrence. Method: Patients with Crohn's disease who had undergone intestinal resection from January 2000 to March 2020 in Peking Union Medical College Hospital were enrolled. Patients were divided into reoperation and non-reoperation group according to whether they had a second operation. And the basic characteristics and the reasons for the primary and second operation were retrospectively analyzed. Meanwhile, patients were divided into low-risk reoperation group and high-risk group based on risk stratification. Kaplan-Meier methods were performed to analyze the cumulative surgical recurrence rate and to compare the recurrence rate in different risk stratification and chi-square tests was used to analyze the effects of different maintenance drugs on reoperation. Result: A total of 160 patients were enrolled in the study. There were 110 males and 50 females, and the age at first operation was (35.6±14.1) years old. There were 40 patients in the reoperation group and 120 patients in the non-reoperation group. According to univariate analysis, the proportion of male gender(P=0.030), penetrating phenotype(P<0.001), history of appendectomy before the primary surgery(P=0.035) and no postoperative maintenance therapy (P<0.001) were higher in surgical recurrence group. In terms of the operation reasons, intestinal obstruction accounted for the highest proportion in the primary operation (26.9%, 43/160), while the intestinal fistula was the most common reason for reoperation (42.5%, 17/40). After the primary surgery, the cumulative reoperation rates at 1, 3, 5 and 10 years were 5.9% (9 cases), 12.3% (17 cases), 21.8% (25 cases) and 37.6% (34 cases), respectively. The ten years cumulative reoperation rate of the high-risk group was 42.8% (31 cases), which was much higher than that of low-risk group (19.8%, 3 cases), and the difference was statistically significant (P=0.006). There was no statistically significant difference in the surgical recurrence rate of low-risk group patients(P=0.076)whether maintenance therapies were added or not, while the recurrence rate of high-risk group patients who did not receive maintenance therapy was higher than those who received immunosuppressant with or without (±) 5-aminosalicylic acid (ASA) (P=0.001) and biological agent±5-ASA (P=0.001), and the difference was statistically significant. Conclusion: Patients with CD are still at risk of reoperation after surgery. Immunosuppressive agents and biologics can prevent patients from reoperation in high-risk groups.
目的： 分析克罗恩病（CD）患者累积再手术率、手术原因及药物对再手术的影响。 方法： 纳入2000年1月至2020年3月于北京协和医院行肠道切除术的CD患者，依据是否再次手术将患者分为再手术组及非再手术组，回顾性分析患者的一般资料、初次及再次手术原因以及初次术后维持治疗；同时将患者按CD不同术后复发危险分层分为复发高危组及低危组，分析总体手术累积复发率及不同危险分层的累积再手术率，并分析不同维持治疗药物对两组患者再手术的影响。 结果： 共纳入160例患者，其中男110例、女50例；手术时年龄（35.6±14.1）岁；再手术组40例，非再手术组120例。再手术组中，男性（P=0.030）、穿通型病变（P<0.001）以及初次手术前阑尾切除史（P=0.035）的患者比例高于非再手术组，初次手术原因中以肠梗阻占比最高（26.9%，43/160），再次手术原因中以肠瘘占比最高（42.5%，17/40）。术后1、3、5及10年累积再手术率分别为5.9%（9例）、12.3%（17例）、21.8%（25例）及37.6%（34例）。低危组患者术后10年累积再手术率为19.8%（3例），高危组患者42.8%（31例），两组患者累积再手术率差异有统计学意义（P=0.006）。低危组患者术后是否加用维持治疗的复发比例差异无统计学意义（P=0.076），而高危组患者中未加用维持治疗的患者较加用免疫抑制剂±（联合或不联合）5-氨基水杨酸（5-ASA）（P=0.001）以及生物制剂±5-ASA（P=0.001）的患者再手术比例高，差异有统计学意义。 结论： CD患者手术后仍有再手术风险，针对高危组给予免疫抑制剂及生物制剂有预防患者再手术的作用。.