Ba'ath M E, Mahmalat M W, Kapur P, Smith N P, Dalzell A M, Casson D H, Lamont G L, Baillie C T
Department of Paediatric Surgery, Royal Liverpool Children's Hospital NHS Trust, Liverpool, UK.
Arch Dis Child. 2007 Apr;92(4):312-6. doi: 10.1136/adc.2006.096875. Epub 2006 May 2.
To evaluate the outcome and morbidity after major surgical interventions for inflammatory bowel disease (IBD).
Retrospective case note analysis of 227 children referred to a tertiary referral centre between 1994 and 2002 for treatment of IBD.
26 of 125 children with Crohn's disease (21%) required surgical management. 13 with disease proximal to the left colon underwent limited segmental resections and primary anastomosis, without significant morbidity. Primary surgery for 13 children with disease distal to the transverse colon included 6 subtotal-colectomies or panprocto-colectomies. All seven children undergoing conservative segmental resections (three with primary anastomosis, four with stoma formation), required further colonic resection or defunctioning stoma formation. All three children undergoing primary anastomosis developed a leak or fistula formation. 22 of 102 children with ulcerative colitis (22%) required surgery. Definitive procedures (n = 17) included J-pouch ileoanal anastomosis (n = 11), ileorectal anastomosis (n = 2), straight ileoanal anastomosis (n = 3), and proctectomy/ileostomy (n = 1). Five children await restorative surgery after subtotal colectomy. Median daily stool frequency after J-pouch surgery was 5 (range 3-15), and 10 of 11 children reported full daytime continence. All three children with straight ileoanal anastomosis had unacceptable stool frequency and remain diverted.
The complication rate after resectional surgery for IBD was 57% for Crohn's disease, and 31% for ulcerative colitis. In children with Crohn's disease, limited resection with primary anastomosis is safe proximal to the left colon. Where surgery is indicated for disease distal to the transverse colon, subtotal or panproctocolectomy is indicated, and an anastomosis should be avoided. Children with ulcerative colitis had a good functional outcome after J-pouch reconstruction. However, the overall failure rate of attempted reconstructive surgery was 24%, largely owing to the poor results of straight ileoanal anastomosis.
评估炎症性肠病（IBD）主要外科手术干预后的结局及发病率。
对1994年至2002年间转诊至一家三级转诊中心接受IBD治疗的227例儿童进行回顾性病历分析。
125例克罗恩病患儿中有26例（21%）需要手术治疗。13例病变位于左半结肠近端的患儿接受了有限节段性切除及一期吻合术，术后发病率不高。13例病变位于横结肠远端的患儿接受的一期手术包括6例次全结肠切除术或全直肠结肠切除术。所有7例行保守性节段性切除的患儿（3例行一期吻合术，4例行造口术）均需要进一步行结肠切除或功能性造口术。所有3例行一期吻合术的患儿均发生了吻合口漏或瘘。102例溃疡性结肠炎患儿中有22例（22%）需要手术。确定性手术（n = 17）包括J形贮袋回肠肛管吻合术（n = 11）、回直肠吻合术（n = 2）、直形回肠肛管吻合术（n = 3）以及直肠切除术/回肠造口术（n = 1）。5例患儿在全结肠切除术后等待恢复性手术。J形贮袋手术后每日排便次数中位数为5次（范围3 - 15次），11例患儿中有10例报告白天完全控便。所有3例行直形回肠肛管吻合术的患儿排便次数均不理想，仍需改道。
IBD切除术后的并发症发生率，克罗恩病为57%，溃疡性结肠炎为31%。对于克罗恩病患儿，在左半结肠近端行有限切除及一期吻合术是安全的。对于横结肠远端病变需行手术治疗时，应行全结肠或全直肠结肠切除术，避免吻合术。溃疡性结肠炎患儿J形贮袋重建术后功能结局良好。然而，重建手术的总体失败率为24%，主要是由于直形回肠肛管吻合术效果不佳。
