Sako Minako, Kimura Hideaki, Arai Katsuhiko, Koganei Kazutaka, Kito Fumihiko, Sugita Akira, Fukushima Tsuneo
Department of Surgery, Yokohama City Hospital, 56 Okazawa-cho, Hodogaya-ku, Yokohama, 240-8555, Japan.
Surg Today. 2006;36(2):162-5. doi: 10.1007/s00595-005-3098-0.
A restorative proctocolectomy has become an elective surgical treatment for patients with ulcerative colitis (UC). In children with UC, however, the role of this procedure has not yet been well evaluated. We investigated the postoperative status of pediatric patients with UC regarding the side effects of steroids, postoperative complications, and growth.
The medical records of 15 patients with UC who underwent a restorative proctocolectomy between August 1993 and October 2003 were retrospectively reviewed.
Their mean age was 12.6 +/- 3.4 years (range 5.7-15.7; boys: 9, girls: 6). All patients had total colitis, except for one who had left-sided colitis. The mean cumulative dose of preoperative prednisolone was 6201 +/- 7980 mg (mean +/- SD). The operative indications were an unsuccessful response to medical treatments in 12 patients (80%) and severe colitis in 3 patients (20%). Surgery was performed in one stage in 6 patients and in two stages in 9 patients. Seven patients (47%) demonstrated growth retardation at the time of operation. Steroid-related complications were seen in 3 cases, i.e., steroid myopathy, glaucoma, and cataracts, respectively. As early postoperative complications, an intestinal obstruction was seen in 2 patients, peritonitis in 1, and pancreatitis in 1. As late complications, anastomotic stenosis was observed in 5 patients, pouchitis in 4, residual proctitis in 3, and anal or proctovaginal fistula in 2. An intestinal obstruction, peristomal pyoderma gangrenosum, and dehydration each was seen in 1 patient. A growth "catch-up" was obtained for all but one patient. All patients became free of corticosteroids.
A restorative proctocolectomy was found to be an effective treatment alternative even in children with UC when conservative therapy proves to be ineffective.
全直肠系膜切除回肠储袋肛管吻合术已成为溃疡性结肠炎（UC）患者的一种选择性外科治疗方法。然而，在儿童UC患者中，该手术的作用尚未得到充分评估。我们调查了小儿UC患者术后的类固醇副作用、术后并发症及生长情况。
回顾性分析1993年8月至2003年10月期间接受全直肠系膜切除回肠储袋肛管吻合术的15例UC患者的病历。
他们的平均年龄为12.6±3.4岁（范围5.7 - 15.7岁；男孩9例，女孩6例）。除1例为左侧结肠炎外，所有患者均为全结肠炎。术前泼尼松龙的平均累积剂量为6201±7980mg（平均值±标准差）。手术指征为12例患者（80%）药物治疗无效，3例患者（20%）为重症结肠炎。6例患者一期手术，9例患者二期手术。7例患者（47%）在手术时出现生长发育迟缓。分别有3例出现类固醇相关并发症，即类固醇肌病、青光眼和白内障。术后早期并发症包括2例肠梗阻、1例腹膜炎和1例胰腺炎。晚期并发症包括5例吻合口狭窄、4例储袋炎、3例残留直肠炎和2例肛门或直肠阴道瘘。各有1例患者出现肠梗阻、造口周围坏疽性脓皮病和脱水。除1例患者外，所有患者均实现了生长“追赶”。所有患者均停用了皮质类固醇。
当保守治疗无效时，全直肠系膜切除回肠储袋肛管吻合术即使对儿童UC患者也是一种有效的治疗选择。
