中国实用外科杂志

中国实用外科杂志 ›› 2025, Vol. 45 ›› Issue (05): 582-588.DOI: 10.19538/j.cjps.issn1005-2208.2025.05.19

• 论著 • 上一篇    下一篇

穿透型克罗恩病行腹腔镜手术治疗有效性及安全性分析

文    明1，孙振亚2，冯登宇1，段    明1，李    毅1，朱维铭1,2   

  1. 1南京大学医学院附属金陵医院（东部战区总医院）普通外科，江苏南京 210002；2南京中医药大学附属医院江苏省中医院炎症性肠病诊疗中心，江苏南京 210029
  • 出版日期:2025-05-01 发布日期:2025-05-28

  • Online:2025-05-01 Published:2025-05-28

摘要： 目的    探讨穿透型克罗恩病（CD）行腹腔镜手术治疗的安全性和有效性。方法    回顾性分析2018年1月至2022年12月南京大学医学院附属金陵医院普通外科收治的行部分肠管切除术的238例穿透型CD病人的临床资料，按手术方式分为腹腔镜组和开放组。倾向性评分匹配（PSM）后比较两组病人近期并发症发生率和远期复发率，并通过Cox回归分析复发的影响因素。结果    经PSM后，共124例穿透型CD病人纳入研究，其中腹腔镜组和开放组各62例。PSM后，两组病人术前基线资料差异无统计学意义（P>0.05）。两组病人近期结局比较，腹腔镜组病人切口感染（4.8% vs. 16.1%，χ²=4.210，P=0.040）和感染性并发症（11.3% vs. 27.4%，χ²=5.170，P=0.023）发生率均低于开放组，差异有统计学意义。两组病人远期结局比较，腹腔镜组病人的内镜复发率（χ²=4.25，P=0.039）和手术复发率（χ²=4.49，P=0.035）均低于开放组，差异有统计学意义。多因素Cox回归模型分析结果显示，腹腔镜手术（HR=0.53，95%CI 0.28-0.90，P=0.047）是影响病人内镜复发的独立保护因素，腹腔镜手术（HR=0.16，95%CI 0.03-0.90，P=0.038）和术前血红蛋白水平（HR=0.94，95%CI 0.89-0.99，P=0.018）是影响病人手术复发的独立保护因素。结论    腹腔镜手术在穿透型CD中安全可行，并且在降低术后远期复发方面具有优势。腹腔镜手术可作为穿透型CD的有效治疗方案。

关键词: 穿透型克罗恩病, 腹腔镜手术, 近期并发症, 手术复发, 内镜复发

Abstract: To investigate the safety of laparoscopic surgery for penetrating Crohn’s disease (CD) and its long-term clinical outcomes. Methods    A retrospective analysis was conducted on the clinical data from 238 patients with penetrating CD who underwent partial intestinal resection at the Department of General Surgery, Jinling Hospital Affiliated to Nanjing University Medical School, between January 2018 and December 2022. Patients were divided into laparoscopic and open surgery groups based on surgical approach. After propensity score matching (PSM), short-term complication rates and long-term recurrence rates were compared between the two groups. Cox regression analysis was used to identify risk factors influencing recurrence. Results    After PSM, 124 patients with penetrating CD were included, with 62 patients in each group. After PSM, there was no statistically significant difference in the preoperative baseline data between the two groups of patients (P>0.05). For short-term outcomes, the laparoscopic group had lower rates of incisional infection (4.8% vs. 16.1%, χ²=4.210, P=0.040) and infectious complications (11.3% vs. 27.4%, χ²=5.170, P=0.023) compared to the open surgery group, with statistically significant differences. For long-term outcomes, the laparoscopic group demonstrated lower endoscopic recurrence (χ²=4.25, P=0.039) and surgical recurrence rates (χ²=4.49, P=0.035), with statistically significant differences. Multivariate Cox regression analysis identified laparoscopic surgery (HR=0.53, 95%CI 0.28-0.90, P=0.047) as an independent protective factor against endoscopic recurrence. Laparoscopic surgery (HR=0.16, 95%CI 0.03-0.90, P=0.038) and hemoglobin level (HR=0.94, 95%CI 0.89-0.99, P=0.018) were independent protective factors against surgical recurrence. Conclusion Laparoscopic surgery is safe and feasible for penetrating CD and offers advantages in reducing long-term postoperative recurrence. It can serve as an effective treatment option for penetrating CD. 

Key words: penetrating Crohn's disease, laparoscopic surgery, short-term complication, surgical recurrence, endoscopic recurrence