DCR：术前应用英夫利昔单抗不增加炎性肠病患者腹腔镜下切除后死亡率

　　近日，《结肠与直肠疾病》（Diseases of the Colon & Rectum）杂志载文评价了英夫利昔单抗对在接受择期腹腔下切除术的炎性肠病（IBD）患者围术期转归的影响。文章发表于2013年第56卷第4期。

　　该文作者Mukta Krane对经过伦理委员会批准后前瞻性收集的数据库进行了回顾性分析。

　　该团队对接受腹腔镜下切除术，术前应用与未应用英夫利昔单抗的患者进行了比较，评价了短期和长期的并发症及死亡率。

　　2004至2011年总共有518名IBD患者进行了择期腹腔镜下切除术，142名患者术前接受了英夫利昔单抗治疗。

　　两组的人口学特征、IBD类型和严重程度、伴随疾病与术式类似。英夫利昔单抗组在术前1月中接受积极药物治疗控制IBD症状的患者数量明显更多（包括类固醇与免疫抑制剂）。手术时间和失血相似。

　　研究者注意到两组的术中并发症发生率均为2%。中转开腹、术后30天总体并发症及死亡率方面没有观察到明显差异。吻合口漏、感染和血栓并发症发生率相似。亚组分析确认溃疡性结肠炎（UC）患者和克罗恩病（CD）患者的总体并发症、感染并发症和血栓并发症的发生率相似。

　　Kane医师的团队评论道：“英夫利昔单抗不引起腹腔镜下切除术后并发症发生率的升高。”

与腹腔镜相关的拓展阅读：

• Surg Endosc：腹腔镜下可调式胃束带术失败后的修正手术
• 腹腔镜肝切除术专家共识和手术操作指南（2013版）
• Lancet：直肠癌腹腔镜与开腹手术如何选择
• 腹腔镜捆绑式肝局部血流阻断术疗效好
• 治疗结直肠疾病：机械人辅助的优于常规腹腔镜手术 更多信息请点击：有关腹腔镜更多资讯

Preoperative Infliximab Therapy Does Not Increase Morbidity and Mortality After Laparoscopic Resection for Inflammatory Bowel Disease
BACKGROUND
The impact of infliximab on the postoperative course of patients with IBD is under debate.
OBJECTIVE
The aim of this study was to evaluate the influence of infliximab on perioperative outcomes in patients undergoing elective laparoscopic resection for IBD.
DESIGN
This study is a retrospective analysis of a prospectively collected, institutional review board-approved database. SETTING, PATIENTS, INTERVENTIONS:: Patients undergoing laparoscopic resection on preoperative infliximab (infliximab group) were compared with patients who did not receive infliximab (noninfliximab group).
MAIN OUTCOME MEASURES
The short-term and long-term morbidity and mortality rates were assessed.
RESULTS
Elective laparoscopic resection for IBD was performed on 518 patients from January 2004 through June 2011; 142 patients were treated with infliximab preoperatively. Both groups had similar demographics, type and severity of IBD, comorbidities, and type of surgery. A significantly higher number of patients in the infliximab group had been on aggressive medical therapy to control symptoms of IBD during the month preceding surgery, including steroids (73.9 vs 58.8%, p = 0.002) and immunosuppressors (32.4 vs 20.5%, p = 0.006). Operative time and blood loss were similar (p = 0.50 and p = 0.34). Intraoperative complication rate was 2.1% in both groups. No significant differences were observed in terms of the conversion rate to laparotomy (6.3% vs 9.3%, p = 0.36), overall 30-day postoperative morbidity (p = 0.93), or mortality (p = 0.61). The rates of anastomotic leak (2.1% vs 1.3%, p = 0.81), infections (12% vs 11.2%, p = 0.92), and thrombotic complications (3.5% vs 5.6%, p = 0.46) were similar. Subgroup analyses confirmed similar rates of overall, infectious, and thrombotic complications regardless of whether patients had ulcerative colitis or Crohn's disease.
LIMITATIONS
This study is subject to the limitations of a retrospective design.
CONCLUSIONS
Infliximab is not associated with increased rates of postoperative complications after laparoscopic resection.