Laituri Carrie A, Fraser Jason D, Garey Carissa L, Aguayo Pablo, Sharp Susan W, Ostlie Daniel J, Holcomb George W, St Peter Shawn D
Department of Surgery, Children's Mercy Hospital, Kansas City, Missouri, USA.
J Laparoendosc Adv Surg Tech A. 2011 Mar;21(2):193-5. doi: 10.1089/lap.2010.0169. Epub 2011 Jan 8.
Definitive management for medically refractory ileocecal Crohn's disease is resection with primary anastomosis. Laparoscopic resection has been demonstrated to be effective in adults. There is a relative paucity of data in the pediatric population. We therefore audited our experience with laparoscopic ileocecectomy in patients with medically refractory ileocecal Crohn's disease to determine its efficacy.
We conducted a retrospective review of all pediatric patients who underwent laparoscopic ileocecal resection for medically refractory Crohn's disease at a single institution from 2000 to 2009.
Thirty patients aged 10-18 years (mean: 15.3 years) with a mean weight of 50 kg (standard deviation: ± 15.5 kg) underwent laparoscopic ileocecectomy for Crohn's disease. Five of these were performed using a single-incision laparoscopic approach. The indications for surgery were obstruction/stricture (21), pain (10), abscess (3), fistula (3), perforation (2), and bleeding (1). Some patient's had multiple indications. There were a total of five abscesses encountered at operation. Eight patients were on total parenteral nutrition at the time of resection. Twenty-five patients (83.3%) were being treated with steroids at operation. The anastomosis was stapled in 26 patients and hand-sewn in 4. Two patients developed a postoperative abscess, and both of them were taking 20 mg of prednisone daily. One patient developed a small bowel obstruction due to a second Crohn's stricture that manifested itself after the more severe downstream obstruction was relieved with ileocecectomy. Of the 5 patients who underwent a single-incision laparoscopic operation, 3 underwent for obstruction/stricture and 2 for perforation. There were no intraoperative or postoperative complications. The patients were followed up for a maximum of 80.7 months (average: 14.7 months; median: 9.7 months). There were no anastomotic leaks or wound infections.
This series demonstrates that laparoscopic ileocecectomy, both single-incision laparoscopic approach and standard laparoscopy, is safe and effective in the setting of medically refractory Crohn's disease in pediatric patients.
对于药物治疗无效的回盲部克罗恩病，其确定性治疗方法是行一期吻合的切除术。腹腔镜切除术已被证明对成人有效。儿科人群中的相关数据相对较少。因此，我们审核了我们对药物治疗无效的回盲部克罗恩病患者行腹腔镜回盲部切除术的经验，以确定其疗效。
我们对2000年至2009年在单一机构接受腹腔镜回盲部切除术治疗药物治疗无效的克罗恩病的所有儿科患者进行了回顾性研究。
30例年龄在10 - 18岁（平均15.3岁）、平均体重50 kg（标准差：±15.5 kg）的患者因克罗恩病接受了腹腔镜回盲部切除术。其中5例采用单切口腹腔镜手术方式。手术指征包括梗阻/狭窄（21例）、疼痛（10例）、脓肿（3例）、瘘管（3例）、穿孔（2例）和出血（1例）。部分患者有多种指征。术中共发现5处脓肿。8例患者在切除时接受全胃肠外营养。25例患者（83.3%）在手术时接受类固醇治疗。26例患者的吻合口采用吻合器吻合，4例采用手工缝合。2例患者术后出现脓肿，且均每日服用20 mg泼尼松。1例患者因第二次克罗恩狭窄导致小肠梗阻，该狭窄在回盲部切除术后解除了更严重的下游梗阻后出现。在接受单切口腹腔镜手术的5例患者中，3例因梗阻/狭窄接受手术，2例因穿孔接受手术。无术中或术后并发症。患者随访时间最长80.7个月（平均14.7个月；中位数9.7个月）。无吻合口漏或伤口感染。
本系列研究表明，无论是单切口腹腔镜手术方式还是标准腹腔镜手术，腹腔镜回盲部切除术在儿科药物治疗无效的克罗恩病患者中是安全有效的。
