위장관 크론병으로 수술한 환자들의 장기 추적 결과
Long-term Result of Surgical Treatment for Crohn’s Enteritis
최상지, 최은경, 박성찬, 박규주,
소속 상세정보
최상지 ( Choi Sang-Ji )
서울대학교 의과대학 외과학교실
최은경 ( Choe Eun-Kyung )
서울대학교 의과대학 외과학교실
박성찬 ( Park Sung-Chan )
서울대학교 의과대학 외과학교실
박규주 ( Park Kyu-Joo )
서울대학교 의과대학 외과학교실
KMID : 0356720080240060409
Abstract
Purpose: We sought to determine the long-term outcome of surgical management for gastrointestinal Crohns’s disease (CD) and to find out whether there is any improvement over the time period.
Methods: We analyzed the records of the 102 patients who underwent surgery for gastrointestinal CD excluding perianal CDbetween 1978 and 2007. A cumulative surgical recurrence rate was analyzed by Kaplan-Meier plots and log-rank tests.
Results: The main sites of CD were ileocecal area in 54.5%, followed by small bowel (29.7%) and large bowel (7.9%). Common indications for operation were obstruction (25.7%), diagnostic purpose (20.8%), and failure of medical treatment (12.9%). The operation performed were ileocolectomy including right hemicolectomy in 53 cases (45.3%), small bowel resection in 38 cases (31.7%), and strictureplasty 12 cases (10.0%, including 11 cases combined with bowel resection). The average follow-up period after operation was 6.4years (range: 0.5∼29 yr, median: 5.3 yr). Among all patients, 22 (21.6%) underwent operations for recurrence. The re-operation rate was higher in the younger patients group (age at diagnosis less than 25 years) (34.1% vs. 12.1%, P＜0.05), and in case of the patients whose length of initial intestinal resection was less than 40 cm (27.9% vs. 7.7%, P＜0.05). The overall cumulative re-operation rates at 5years, 10years and 15years were 15%, 25%, and 60%, respectively.
Conclusions: Despite recent advances in medical therapy, the cumulative re-operation rate of patients operated for gastrointestinal CD remains similar to our previous report in 1997.
키워드
크론병;수술;재발;치료결과;추적관찰연구
Crohn’s disease;Surgery;Recurrence;Treatment outcome ;Follow-up
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