The effects of surgery treatment on the diagnostic delay of Crohn's disease in early stage and analysis of risk factors associated with surgery / 实用医学杂志

ABSTRACT

Objective To explore the effects of surgery treatment on the diagnostic delay of Crohn's dis-ease(CD)in early stage. Methods The effects of surgical operation on diagnostic delay of early stage CD were an-alyzed,and the risk factors that in high surgical rate on early diagnosis were evaluated by comparing the surgical cases with non-surgical cases before the diagnosis of CD.Results The ratio of male and female in the total 215 pa-tients with CD was 1.7 to 1.There were 114 cases with complications including 75 cases with surgery before diagno-sis,39 cases with non-surgical complications and 101 cases with no complications.The age of onset and age of di-agnosis in the three groups were significantly different(P < 0.05),and there was no significant difference in the time of diagnosis(P > 0.05). The most common complications were perianal lesion(p,abscesses and/or fistula) (49.1%),intestinal obstruction(23.7%),and the diseases of appendix(12.3%).The most common causes of pre-operative diagnosis were perianal lesion(38.7%),the lesion of appendix(17.3%),intestinal obstruction(16.0%) and the abdominal surgery(10.5%)whereas intestinal perforation is most easily recognized by histopathology. The rate of male surgery was high whereas the incidence of female complications was low. All three groups of lesions were found to be in ileocolon(L3)in which the operation group with pure small intestine was significantly higher than that in the group with no complications and in the group with non-surgical complications(P<0.05).Also the proportion of diseases behaving stricturing(B2)+penetrating(B3)was 60%,but the complication group behaving inflammatory(B1)+B2 was 87.2%,the group with no complications behaving B1 reached 68.3%.and The compli-cation group behaving P was 61.5% which was higher than the operation group(44.0%).There was a significant dif-ference between the three groups(P<0.001).Conclusions Diagnostic delay of CD on the early was significantly associated with surgery operation. Male,age 17~40,lesion site L3 or intestinal-type,disease behaving B2 and B3,were the high risk factors for preoperative surgery;while women,aged 17-40,with or without chronic compli-cations,were more likely to obtain early diagnosis,less surgical risk,and relatively good prognosis.Perianal lesion were early characteristic expressions of CD and could be used as an regularization indicator for screening.The sec-ond was the recurrent intestinal obstruction.most of the stomach resection and the repeated diarrhea after gallblad-der should be awared of CD.