摘要
Background:Despitemajor advances in themedicalmanagement of Crohn’s disease(CD),a significant proportion of patients will require surgery within 5 years of diagnosis.Malnutrition is an independent risk factor for adverse post-operative outcomes following gastrointestinal surgery.Data on the value of pre-operative total parenteral nutrition(TPN)in CD patients aremixed and there is a paucity of data in the biologic era.We aimed to define the role of pre-operative TPN in this population.Methods:This was a retrospective cohort study conducted at a tertiary referral center.CD patients who underwent major abdominal surgery were identified.Patients receiving pre-operative TPN were compared to controls.We compared the incidence of 30-day infectious and non-infectious post-operative complications between the two groups.Results:A total of 144 CD patients who underwent major abdominal surgery between March 2007 and March 2017 were included.Fifty-five patients who received pre-operative TPN were compared to 89 controls.Twenty-one(14.6%)patients developed infectious complications(18.2%in TPN group vs 12.3%in non-TPN group,P=0.34)and 23(15.9%)developed noninfectious complications(14.5%in TPN group vs 16.9%in non-TPN group,P=0.71).In a multivariate analysis,controlling for differences in baseline disease severity and malnutrition between groups,patients receiving pre-operative TPN for60 days had significantly lower odds of developing non-infectious complications(odds ratio 0.07,95%confidence interval:0.01–0.80,P=0.03).Weight loss of>10%in the past 6 months was a significant predictor of post-operative complications.Conclusions:In a subset of malnourished CD patients,TPN is safe and allows comparable operative outcomes to controls.Pre-operative TPN for60 days reduced post-operative non-infectious complications without associated increase in infectious complications.
背景:尽管克罗恩病(CD)的药物治疗取得了重大进展,但仍有相当一部分患者在诊断后5年内需要接受外科手术治疗。营养不良是胃肠手术疗效欠佳的独立危险因素。术前全胃肠外营养(TPN)在CD患者中的应用价值,各项研究数据并不一致,而且缺少生物治疗时代的相关研究数据。本研究旨在明确TPN在CD手术患者中的应用价值。方法:这是一项在一家三级转诊中心完成的回顾性队例研究。纳入接受主要腹部手术的CD患者,按术前有无接受TPN治疗分为TPN组与非TPN组。比较两组患者术后30天感染性与非感染性并发症发生率。结果:纳入2007年3月至2017年3月间行主要腹部手术的144例CD患者,其中55例接受术前TPN治疗,非TPN组89例。21例(14.6%)患者术后出现感染性并发症,其中TPN组与非TPN组发生率分别为18.2%和12.3%(P=0.34);23例(15.9%)术后发生非感染性并发症,其中TPN组与非TPN组发生率分别为14.5%和16.9%(P=0.71)。采用多因素分析校正两组间基线疾病严重度和营养不良程度的差异后,术前TPN治疗≥60天的患者,其术后发生非感染性并发症的风险显著降低(OR=0.07,95%CI:0.01-0.80,P=0.03)。近6个月内体重下降>10%则是术后并发症的危险因素。结论:对于营养不良的CD患者,TPN是安全的,而且可以使其获得与营养正常CD患者相当的手术疗效。术前行≥60天TPN治疗可减少术后非感染性并发症的发生,而且并不会增加感染性并发症的发生概率。
