spracticeХирургическая практикаSurgical practice (Russia)2223-2427АНО "Консорциум "Медицинская техника"10.38181/2223-2427-2023-1-4spractice-386Research ArticleХИРУРГИЯSURGERYХирургическое лечение болезни Крона: риск развития осложненийSurgical treatment of Crohn's disease: the risk of complicationshttps://orcid.org/0000-0001-9439-9873ДаниловМ. А.DanilovM. A.

Данилов Михаил Александрович - кандидат медицинских наук, заведующий отделением колопроктологии.

111123, Москва, шоссе Энтузиастов, 86

Mikhail A. Danilov - Head of the Department of Coloproctology, Loginov Moscow Clinical Scientific Centre.

Shosse Entuziastov 86, Moscow, 111123

m.danilov@mknc.ruhttps://orcid.org/0000-0003-3363-6841ЛеонтьевА. В.LeontyevA. V.

Леонтьев Александр Владимирович - кандидат медицинских наук, врач-колопроктолог.

111123, Москва, шоссе Энтузиастов, 86

Aleksandr V. Leontyev - Coloproctologist, Loginov Moscow Clinical Scientific Centre.

Shosse Entuziastov 86, Moscow, 111123

a.leontev@mknc.ruhttps://orcid.org/0000-0003-0641-0572БайчоровА. Б.BaichorovA. B.

Байчоров Аслан Борисович - кандидат медицинских наук, врач-колопроктолог.

111123, Москва, шоссе Энтузиастов, 86

Aslan B. Baichorov - Coloproctologist, Loginov Moscow Clinical Scientific Centre.

Shosse Entuziastov 86, Moscow, 111123

a.baichorov@mknc.ruhttps://orcid.org/0000-0002-8599-8089АбдулатиповаЗ. М.AbdulatipovaZ. M.

Абдулатипова Заира Магомедовна - кандидат медицинских наук, врач-колопроктолог.

111123, Москва, шоссе Энтузиастов, 86

Zaira M. Abdulatipova - Coloproctologist, Loginov Moscow Clinical Scientific Centre.

Shosse Entuziastov 86, Moscow, 111123

z.abdulatipova@yandex.ruhttps://orcid.org/0000-0001-5436-3630СаакянГ. Г.SaakyanG. G.

Саакян Георгий Германович - кандидат медицинских наук, врач-колопроктолог.

111123, Москва, шоссе Энтузиастов, 86

Georgiy G. Saakyan - Coloproctologist, Loginov Moscow Clinical Scientific Centre.

Shosse Entuziastov 86, Moscow, 111123

g.saakian@mknc.ruhttps://orcid.org/0000-0001-5141-1692ДемидоваА. А.DemidovaA. A.

Демидова Анастасия Александровна - аспирант, отделение колопроктологии.

111123, Москва, шоссе Энтузиастов, 86

Anastasiya A. Demidova - PhD student, Department of Coloproctology, Loginov Moscow Clinical Scientific Centre.

Shosse Entuziastov 86, Moscow, 111123

anastasia.demidova0808@gmail.comМосковский клинический научно-практический центр имени А.С. ЛогиноваРоссияLoginov Moscow Clinical Scientific CentreRussian Federation202303052023014252Copyright © Данилов М.А., Леонтьев А.В., Байчоров А.Б., Абдулатипова З.М., Саакян Г.Г., Демидова А.А., 20232023Данилов М.А., Леонтьев А.В., Байчоров А.Б., Абдулатипова З.М., Саакян Г.Г., Демидова А.А.Danilov M.A., Leontyev A.V., Baichorov A.B., Abdulatipova Z.M., Saakyan G.G., Demidova A.A.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.spractice.ru/jour/article/view/386Цель

Цель: оценка влияния биологической терапии на факторы риска послеоперационных осложнений.

Материалы и методы

Материалы и методы. В исследование были включены 116 пациентов, оперированных по поводу болезни Крона. Средний возраст пациентов составил 38,2 года, среди них 65 мужчин (56 %) и 51 женщина (44 %). Было проанализировано влияние различных факторов на осложнения в послеоперационном периоде с использованием программного обеспечения IBM-SPSS для Mac версии 22.0 и Microsoft Excel 1997—2003.

Результаты

Результаты. Биологическую терапию получали 32,7 % исследуемых, послеоперационные осложнения развились у 31 % прооперированных пациентов. Не было выявлено связи между получением биологической терапии и риском послеоперационных осложнений. Фактором риска стало формирование стомы и оперативное вмешательство по экстренным показаниям.

Выводы

Выводы. Важной задачей перед оперативным лечением при болезни Крона является тщательная предоперационная подготовка и оценка всех факторов риска осложнений хирургического вмешательства мультидисциплинарной командой.

Aim: assessment of the impact of biological therapy on risk factors for postoperative complications. Materials and methods: the study included 116 patients operated on for Crohn's disease. The mean age of the patients was 38.2 years, among them 65 men (56 %) and 51 women (44 %). The influence of various factors on complications in the postoperative period was analyzed using the IBM-SPSS software for Mac version 22.0 and Microsoft Excel 1997-2003. Results: 32.7 % of the patients received biological therapy, and postoperative complications developed in 31 % of the operated patients. There was no association between receiving biological therapy and the risk of postoperative complications. The risk factor was the formation of a stoma and surgery for emergency indications. Conclusion: an important task before surgical treatment for Crohn's disease is a thorough preoperative preparation and assessment of all risk factors for complications of surgical intervention by a multidisciplinary team.

болезнь Кронахирургическое лечениестриктурасвищевая формариск осложненийфакторы рискаCrohn's diseasesurgical treatmentstricturefistula formrisk of complicationsrisk factorsReferencesSakurai Kimura CM, Scanavini Neto A, Queiroz NSF, Horvat N, Camargo MGM, Borba MR, Sobrado CW, Cecconello I, Nahas SC. Abdominal Surgery in Crohn's Disease: Risk Factors for Complications. Inflamm Intest Dis. 2021. Feb 6(1):18—24. https://doi.org/10.1159/000510999.Sakurai Kimura CM, Scanavini Neto A, Queiroz NSF, Horvat N, Camargo MGM, Borba MR, Sobrado CW, Cecconello I, Nahas SC. Abdominal Surgery in Crohn's Disease: Risk Factors for Complications. Inflamm Intest Dis. 2021. Feb 6(1):18—24. https://doi.org/10.1159/000510999.Oresland T, Faerden AE. Surgery in the age of biological treatment. Scand J Gastroenterol. 2015. Jan 50(1):121—127. https://doi.org/10.3109/00365521.2014.972445.Oresland T, Faerden AE. Surgery in the age of biological treatment. Scand J Gastroenterol. 2015. Jan 50(1):121—127. https://doi.org/10.3109/00365521.2014.972445.Wong DJ, Roth EM, Feuerstein JD, Poylin VY. Surgery in the age of biologics. Gastroenterol Rep (Oxf). 2019. Apr 7(2):77—90. https://doi.org/10.1093/gastro/goz004.Wong DJ, Roth EM, Feuerstein JD, Poylin VY. Surgery in the age of biologics. Gastroenterol Rep (Oxf). 2019. Apr 7(2):77—90. https://doi.org/10.1093/gastro/goz004.Kirchhoff P, Clavien PA, Hahnloser D. Complications in colorectal surgery: risk factors and preventive strategies. Patient Saf Surg. 2010. Mar 25;4(1):5. https://doi.org/10.1186/1754-9493-4-5.Kirchhoff P, Clavien PA, Hahnloser D. Complications in colorectal surgery: risk factors and preventive strategies. Patient Saf Surg. 2010. Mar 25;4(1):5. https://doi.org/10.1186/1754-9493-4-5.Bossuyt P, Debeuckelaere C, Ferrante M, Vanbeckevoort D, Billiet T, Wolthuis A, van Assche G, D'Hoore A, Vermeire S. The operative risk and natural history after the diagnosis of ileal penetrating Crohn's disease. Eur J Gastroenterol Hepatol. 2018. May 30(5):539—545. https://doi.org/10.1097/MEG.0000000000001091.Bossuyt P, Debeuckelaere C, Ferrante M, Vanbeckevoort D, Billiet T, Wolthuis A, van Assche G, D'Hoore A, Vermeire S. The operative risk and natural history after the diagnosis of ileal penetrating Crohn's disease. Eur J Gastroenterol Hepatol. 2018. May 30(5):539—545. https://doi.org/10.1097/MEG.0000000000001091.Галлямов Э. А., Агапов М. А., Луцевич О. Э., Кубышкин В. А., Какоткин В. В., Толстых М. П. Раннее закрытие илеостом у больных раком прямой кишки. Первые результаты рандомизированного мультицентрового исследования. Хирургия. Журнал им. Н. И. Пирогова. 2019;(6):35—40.Galliamov EA, Agapov MA, Lutsevich O, Kubyshkin VA, Kakotkin VV, Tolstykh MP. Early ileostomy closure in patients with rectal cancer. Primary results of the randomized controlled multicenter trial. Pirogov Russian Journal of Surgery = Khirurgiya. Zurnal im. N. I. Pirogova. 2019;(6):35—40 (in Russ., in Engl.). https://doi. org/10.17116/hirurgia201906135.Hyman NH, Cheifetz AS. PUCCINI: Safety of Anti-TNF in the Perioperative Setting. Gastroenterology. 2022. Jul 163(1):44—46. https://doi.org/10.1053/j.gastro.2022.04.050.Hyman NH, Cheifetz AS. PUCCINI: Safety of Anti-TNF in the Perioperative Setting. Gastroenterology. 2022. Jul 163(1):44—46. https://doi.org/10.1053/j.gastro.2022.04.050.Lightner AL, McKenna NP, Alsughayer A, Harmsen WS, Taparra K, Parker ME, Raffals LE, Loftus EV Jr. Biologics and 30-Day Postoperative Complications After Abdominal Operations for Crohn's Disease: Are There Differences in the Safety Profiles? Dis Colon Rectum. 2019. Nov 62(11):1352—1362. https://doi.org/10.1097/DCR.0000000000001482.Lightner AL, McKenna NP, Alsughayer A, Harmsen WS, Taparra K, Parker ME, Raffals LE, Loftus EV Jr. Biologics and 30-Day Postoperative Complications After Abdominal Operations for Crohn's Disease: Are There Differences in the Safety Profiles? Dis Colon Rectum. 2019. Nov 62(11):1352—1362. https://doi.org/10.1097/DCR.0000000000001482.Peyrin-Biroulet L, Salleron J, Filippi J, Reenaers C, Antunes O, Filipe V, Louis E, Hebuterne X, Roblin X. Anti-TNF Monotherapy for Crohn's Disease: a 13-year Multicentre Experience. J Crohns Colitis. 2016. May 10(5):516—524. https://doi.org/10.1093/ecco-jcc/jjw008.Peyrin-Biroulet L, Salleron J, Filippi J, Reenaers C, Antunes O, Filipe V, Louis E, Hebuterne X, Roblin X. Anti-TNF Monotherapy for Crohn's Disease: a 13-year Multicentre Experience. J Crohns Colitis. 2016. May 10(5):516—524. https://doi.org/10.1093/ecco-jcc/jjw008.Abdalla S, Brouquet A, Maggiori L, Zerbib P, Denost Q, Germain A, Cotte E, Beyer-Berjot L, Munoz-Bongrand N, Desfourneaux V, Rahili A, Duffas JP, Pautrat K, Denet C, Bridoux V, Meurette G, Faucheron JL, Loriau J, Guillon F, Vicaut E, Benoist S, Panis Y, Lefevre JH. Postoperative Morbidity After Iterative Ileocolonic Resection for Crohn's Disease: Should we be Worried? A Prospective Multicentric Cohort Study of the GETAID Chirurgie. J Crohns Colitis. 2019. Dec 10;13(12):1510—1517. https://doi.org/10.1093/ecco-jcc/jjz091.Abdalla S, Brouquet A, Maggiori L, Zerbib P, Denost Q, Germain A, Cotte E, Beyer-Berjot L, Munoz-Bongrand N, Desfourneaux V, Rahili A, Duffas JP, Pautrat K, Denet C, Bridoux V, Meurette G, Faucheron JL, Loriau J, Guillon F, Vicaut E, Benoist S, Panis Y, Lefevre JH. Postoperative Morbidity After Iterative Ileocolonic Resection for Crohn's Disease: Should we be Worried? A Prospective Multicentric Cohort Study of the GETAID Chirurgie. J Crohns Colitis. 2019. Dec 10;13(12):1510—1517. https://doi.org/10.1093/ecco-jcc/jjz091.Huang W, Tang Y, Nong L, Sun Y. Risk factors for postoperative intra-abdominal septic complications after surgery in Crohn's disease: A meta-analysis of observational studies. J Crohns Colitis. 2015. Mar 9(3):293—301. https://doi.org/10.1093/ecco-jcc/jju028.Huang W, Tang Y, Nong L, Sun Y. Risk factors for postoperative intra-abdominal septic complications after surgery in Crohn's disease: A meta-analysis of observational studies. J Crohns Colitis. 2015. Mar 9(3):293—301. https://doi.org/10.1093/ecco-jcc/jju028.Luong TV, Grandt SD, Negoi I, Palubinskas S, El-Hussuna A. Preoperative factors associated with prolonged postoperative in-hospital length of stay in patients with Crohn's disease undergoing intestinal resection or strictureplasty. Int J Colorectal Dis. 2019. Nov 34(11):1925—1931. https://doi.org/10.1007/s00384-019-03418-8.Luong TV, Grandt SD, Negoi I, Palubinskas S, El-Hussuna A. Preoperative factors associated with prolonged postoperative in-hospital length of stay in patients with Crohn's disease undergoing intestinal resection or strictureplasty. Int J Colorectal Dis. 2019. Nov 34(11):1925—1931. https://doi.org/10.1007/s00384-019-03418-8.Shental O, Tulchinsky H, Greenberg R, Klausner JM, Avital S. Positive histological inflammatory margins are associated with increased risk for intra-abdominal septic complications in patients undergoing ileocolic resection for Crohn's disease. Dis Colon Rectum. 2012. Nov 55(11):1125—1130. https://doi.org/10.1097/DCR.0b013e318267c74c.Shental O, Tulchinsky H, Greenberg R, Klausner JM, Avital S. Positive histological inflammatory margins are associated with increased risk for intra-abdominal septic complications in patients undergoing ileocolic resection for Crohn's disease. Dis Colon Rectum. 2012. Nov 55(11):1125—1130. https://doi.org/10.1097/DCR.0b013e318267c74c.Yoon YS, Stocchi L, Holubar S, Aiello A, Shawki S, Gorgun E, Steele SR, Delaney CP, Hull T. When should we add a diverting loop ileostomy to laparoscopic ileocolic resection for primary Crohn's disease? Surg Endosc. 2021. Jun 35(6):2543—2557. https://doi.org/10.1007/s00464-020-07670-w.Yoon YS, Stocchi L, Holubar S, Aiello A, Shawki S, Gorgun E, Steele SR, Delaney CP, Hull T. When should we add a diverting loop ileostomy to laparoscopic ileocolic resection for primary Crohn's disease? Surg Endosc. 2021. Jun 35(6):2543—2557. https://doi.org/10.1007/s00464-020-07670-w.Ghoneima AS, Flashman K, Dawe V, Baldwin E, Celentano V. High risk of septic complications following surgery for Crohn's disease in patients with preoperative anaemia, hypoalbuminemia and high CRP. Int J Colorectal Dis. 2019. Dec 34(12):2185—2188. https://doi.org/10.1007/s00384-019-03427-7.Ghoneima AS, Flashman K, Dawe V, Baldwin E, Celentano V. High risk of septic complications following surgery for Crohn's disease in patients with preoperative anaemia, hypoalbuminemia and high CRP. Int J Colorectal Dis. 2019. Dec 34(12):2185—2188. https://doi.org/10.1007/s00384-019-03427-7.Tiberi A, Pesi B, Giudici F, Zambonin D, Nelli T, Cupellini C, Ficari F, Cianchi F, Scaringi S. Laparoscopic 50 ileo-colic resection and right hemicolectomy for Crohn's disease and colon cancer: a preliminary comparative study on post-operative outcome. Updates Surg. 2020. Sep 72(3):821—826. https://doi.org/10.1007/s13304-020-00769-8.Tiberi A, Pesi B, Giudici F, Zambonin D, Nelli T, Cupellini C, Ficari F, Cianchi F, Scaringi S. Laparoscopic 50 ileo-colic resection and right hemicolectomy for Crohn's disease and colon cancer: a preliminary comparative study on post-operative outcome. Updates Surg. 2020. Sep 72(3):821—826. https://doi.org/10.1007/s13304-020-00769-8.

The authors declare that there are no conflicts of interest present.