| Objective 1.To understand the operation of CD patients and explore the risk factors of surgery in patients with CD. 2 To understand the postoperative clinical recurrence of patients with CD,preliminary observe the postoperative endoscopic recurrence,and understand the drug treatment after surgery in patients with CD at the same time, then explore the risk factors of postoperative recurrence in patients with CD.Methods From January 2008 to December 2013,226 hospitalized CD patients in the Department of the First Affiliated Hospital of Medical University Of Anhui were clollected, Rule out the patients of diagnostic uncertainty, the follow-up is not in conformity with the CD natural progression,incomplete data and lost to follow-up, finally 183 cases met the diagnostic criteria for CD. 1.Formulate the questionnaire for CD patients.We retrieved CD patients from January 2008 to December 2013 in gastroenterology discharge of our hospital and recorded of demographic data, past medical history, smoking history, drinking history, clinical data, laboratory parameters, endoscopy, imaging science examination and treatment situation and so on detailly. The first time of hospitalization in 2008 in gastroenterology discharge of our hospital as the starting point of the clinical research, the death or the time of diagnosis does not conform to CD or prognosis of December 31, 2014 as a clinical endpoint of the research. We followed the patients’ prognosis through our hospital outpatient visits, hospitalization, telephone and letters and the follow-up period lasted at least 12 months. 2.Screened 46 patients who underwent surgery as operation group and 137 non-surgical patients served as controls. Then the operation group was divided into clinical recurrence group and non clinical recurrence group,clinical data were compared between groups, the risk factors for surgery and postoperative recurrence in CD patients were assessed by us.Results 1.Among the 183 CD patients,the operation rate was 25.1%(46/183). 2.The preoperative diagnosis of CD was 13%(6/46), mainly misdiagnosed as acute appendicitis(62.5%) and colon cancer(25.0%). 3.Univariate analysis showed that smoking patients’ surgery rate was significantly higher than that in non smoking patients(x2=12.012,P=0.001).The difference of surgical rate between the patients with penetration, stenosis and non stenosis non penetrating was statistically significant(x2=38.872,P<0.001). Multivariate Logistic analysis showed disease behavior stenosis(OR= 5.836, 95%CI=2.199 ~ 15.487, P<0.001), penetrating(OR= 25.706, 95%CI=7.091 ~ 93.190, P<0.001) were independent risk factors for surgery. 4.The clinical recurrence rate was 39.1%(18/46),65.2%(30/46) underwent endoscopic review after surgery,endoscopic recurrence rate was 60%(18/30), endoscopic and clinical recurrence rate was 40%(12/30), and the endoscopic recurrence rate but no clinical recurrence was 20%(6/30).8 cases had no medical prophylaxes, 87.5%(7/8) clinical recurrence; 38 cases had medical prophylaxes, 28.9%(11/38) clinical recurrence. 5.Univariate analysis showed the clinical relapse rate after surgery in smoking, perianal disease,and no medical prophylaxis patients was significantly higher than that of non- smoking, no perianal lesions and no medical prophylaxis(x2 =5.347,7.017, 9.512, respectively;P value = 0.021, 0.008, 0.002 respectively). Multivariate Logistic analysis showed perianal lesions(OR= 23.550, 95%CI=1.311 ~ 422.912, P=0.032) and no medical prophylaxis(OR= 58.701, 95%CI=1.803 ~ 1991, P=0.022) were independent risk factors for postoperative recurrence.Conclusion 1.The operation rate of CD patients was as high as 25.1%, the diagnosis is difficult and the rate of misdiagnosis is high; 2. Structuring and penetrating disease behavior are risk factors for surgery; 3.39.1% patients with CD were easy to relapse after surgery,perianal disease is risk factor for postoperative clinical recurrence,and no medical prophylaxes is another risk factor for postoperative clinical recurrence. |
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