Dept. of Surgery, Royal Free Hospital, Hampstead, London, NW3 2QG, United Kingdom.
J Crohns Colitis. 2007 Dec;1(2):82-6. doi: 10.1016/j.crohns.2007.08.003. Epub 2007 Sep 27.
To investigate the outcome of limited ileo-caecal resection in children with localised Crohn's disease (CD) and determine predictors of further surgery.
Review of children diagnosed with CD and operated on for ileo-caecal disease from 1995 to 2005. Age at diagnosis, endoscopic disease distribution, indication for surgery, site of recurrence and date of last follow-up were recorded. Surgery required removal of only the ileo-caecal junction and caecal pole with removal of the minimum terminal ileal length.
Thirty seven children underwent intestinal resection. Time between primary operation and most recent follow-up was 3.8 years (range 1 month-8.8 years). Indications for surgery were obstruction/stricture (20), treatment-resistant disease (13) and abscess/perforation peritonitis (4). Follow-up was available in 32. Nine (28%) required re-laparotomy. Median time to second laparotomy was 12 months (range 4-58 months). Eighteen children required no endoscopies after surgery (median follow-up 3.4 years).
Most conservative surgery occurs about 2 years after diagnosis. About 1 in 4 children have a further laparotomy within 12 months. Over half of these require division of adhesions. Limited ileo-caecal resection for localized Crohn's disease is not associated with early peri-anastomotic recurrence. Developments in laparoscopic surgery are likely to further reduce complications from adhesions.
研究局限性回肠-结肠切除术治疗儿童局限性克罗恩病（CD）的结果，并确定再次手术的预测因素。
回顾性分析 1995 年至 2005 年期间诊断为 CD 并接受回肠-结肠疾病手术的儿童。记录诊断时的年龄、内镜疾病分布、手术指征、复发部位和末次随访日期。手术仅需切除回肠-结肠交界处和盲肠末端，保留最短的末端回肠长度。
37 例患儿接受了肠道切除术。初次手术至最近随访的时间为 3.8 年（1 个月至 8.8 年）。手术指征为梗阻/狭窄（20 例）、治疗抵抗性疾病（13 例）和脓肿/穿孔性腹膜炎（4 例）。32 例患儿可获得随访。9 例（28%）需要再次剖腹手术。第二次剖腹手术的中位时间为 12 个月（4-58 个月）。18 例患儿手术后无需行内镜检查（中位随访 3.4 年）。
大多数保守手术发生在诊断后约 2 年。约 1/4 的患儿在 12 个月内需要再次剖腹手术。其中一半以上需要分离粘连。局限性回肠-结肠切除术治疗局限性克罗恩病并不伴有早期吻合口周围复发。腹腔镜手术的发展可能进一步减少粘连相关并发症。
