目的:总结克罗恩病(Crohn's disease,CD)肠切除术后复发的预测指标,探讨预防策略.方法:分析2013年8月至2016年8月307例接受肠切除术的CD患者资料.按照患者术后复发情况分别纳入复发组、未复发组,计算患者肠切除术后复发率并比较两组患者基线临床资料及治疗方案,运用多因素回归分析,总结影响CD肠切除术后复发的危险因素,分析预防策略.结果:307例患者随访时间10~46个月,平均(21.04±6.38)个月,随访期间内镜复发89例,临床复发59例,合计112例(36例患者同时符合内镜复发与临床复发标准),复发率为36.48%,其中46例(41.07%)患者再次手术.Logistic多因素回归分析得出CDAI指数≥150、吸烟、营养不良、合并肛周病变是影响CD肠切除术后复发的独立危险因素,术后预防用药为保护性因素(P<0.05).结论:CD肠切除术后复发与手术时机、并发症、营养状态及吸烟史有关,早期戒烟、治疗肛周病变、于缓解期开展手术治疗并注重围术期营养支持与预防性药物的应用,有助于降低CD患者术后复发率.%Objective: The objective of this study was to summarize the predictive index of Crohn's disease (CD) enterotomy recurrence and to explore its precautionary measures. Methods: Clinical data of 307 enterotomy patients from August 2013 to August 2016 were analyzed. The patients were divided into recurrence group and non-recurrence group based on their recurrence status. The recurrence rate was calculated and their baseline data and therapy between these two groups were compared. The risk factors influencing the recurrence were summarized by using multi-factor regression analysis, and its precautionary measures were analyzed. Results: 307 patients were followed up ranging from 10 to 46 months, with the average of 21.04±6.38 months. During the follow up, 89 relapsed in endoscopy examination and 59 in clinical, totaling 112 cases, including 36 cases met both the endoscopy and clinical standards. The recurrence rate was 36.48% and 46 cases underwent reoperation. Logistic analysis showed that Crohn's disease activity index (CDAI over 150), smoking, innutrition and perianal lesions were the independent risk factors and the postoperative prophylactic the protective factor (P<0.05). Conclusion: The recurrence of CD is closely correlated with the surgery timing, complications, nutrition and smoking. Smoking quitting, perianal lesions treatment, surgery conduction in remission period and nutrition enhancement and precautionary medication employment in perioperative period make great contribution to decreasing the recurrence rate of CD.
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