Department of Surgery, Children's Mercy Hospitals and Clinics, Kansas City, Missouri 64105, USA.
J Surg Res. 2011 Sep;170(1):38-40. doi: 10.1016/j.jss.2011.02.011. Epub 2011 Mar 11.
Colectomy is the definitive treatment for ulcerative colitis (UC) to remove the inflammatory burden. Crohn's disease, however, can affect any portion of the bowel with a propensity to involve the terminal ileum. In some patients with fulminant colitis, distinction between the two is imperfect. Manifestations of Crohn's after colectomy can be devastating because the ileum is needed for restoration of continuity. There is currently little information in the pediatric literature addressing this concern. Therefore, we reviewed all of our patients who underwent colectomy for inflammatory bowel disease to evaluate the risk of subsequent Crohn's manifestations and to document the outcomes.
A two-center retrospective review of children who underwent colectomy for IBD from January 2000 to July 2010 was performed. Demographic, diagnostic, management, and outcome variables were recorded.
We identified 70 patients who underwent colectomy for UC. The mean age at diagnosis was 12 y ± 7 y, and 59% were female. Clinical diagnosis prior to colectomy was UC in 90%, and indeterminate colitis in 10%. There was discordance between clinical and pathologic diagnosis in five patients, two patients were clinically diagnosed with UC but had an indeterminate biopsy, and three patients were clinically diagnosed as indeterminate colitis with a biopsy confirming UC. Indications for colectomy were refractory bleeding in 63%, failure of medical treatment in 28%, toxic megacolon in 6%, and perforation in 3%. A restorative pouch was created after colectomy in 46% using a two-stage approach while, 53% were managed with an initial colectomy and three-stage approach. In one patient, Crohn's was intraoperatively diagnosed from the operative colectomy specimen. This patient had a clinical diagnosis of UC with concordant biopsy prior to surgery. After total abdominal colectomy, 68 patients went on to ileal pouch anal anastomosis by either a two-stage or three-stage approach. In these patients, nine (13%) had a change in their diagnosis to Crohn's after reconstruction. Crohn's complications requiring an operation consisted of two patients with anastomotic dilations, four patients with fistulotomies, and one patient with perianal abscess drainage procedures.
In the children studied, 13% had a diagnostic change to Crohn's disease, and 13% were diagnosed with Crohn's after ileal pouch-anal anastomosis (IPAA). In patients with IPAA and Crohn's, there were more operative interventions for perianal disease.
结肠切除术是溃疡性结肠炎（UC）的明确治疗方法，可切除炎症负担。然而，克罗恩病可以影响肠道的任何部位，而且倾向于累及末端回肠。在一些暴发性结肠炎患者中，两种疾病的鉴别并不完美。结肠切除术后克罗恩病的表现可能是毁灭性的，因为连续性恢复需要回肠。目前，儿科文献中关于这方面的信息很少。因此，我们回顾了所有因炎症性肠病而行结肠切除术的患者，以评估随后发生克罗恩病表现的风险，并记录其结局。
对 2000 年 1 月至 2010 年 7 月期间在两个中心接受结肠切除术治疗 IBD 的儿童进行了回顾性分析。记录人口统计学、诊断、治疗和结局变量。
我们共纳入 70 例行结肠切除术治疗 UC 的患者。诊断时的平均年龄为 12 岁±7 岁，59%为女性。术前临床诊断为 UC 者占 90%，诊断为不确定结肠炎者占 10%。5 例患者临床和病理诊断不一致，2 例临床诊断为 UC，但活检为不确定结肠炎，3 例临床诊断为不确定结肠炎，但活检为 UC。结肠切除术的指征为：出血难治性 63%、药物治疗无效 28%、中毒性巨结肠 6%、穿孔 3%。46%的患者采用两阶段法行结肠切除术后造口术，53%的患者采用初始结肠切除术和三阶段法。1 例患者术中从手术切除的结肠标本中诊断为克罗恩病。该患者术前临床诊断为 UC，活检与临床诊断一致。全结肠切除术后，68 例患者行回肠贮袋肛管吻合术（IPAA），其中 2 例采用两阶段法，66 例采用三阶段法。这些患者中，有 9 例（13%）在重建后诊断为克罗恩病。需要手术治疗的克罗恩病并发症包括：2 例吻合口扩张，4 例肠瘘切开术，1 例肛周脓肿引流术。
在本研究中，13%的患者诊断为克罗恩病，13%的患者在接受回肠贮袋肛管吻合术后诊断为克罗恩病。在接受 IPAA 治疗且诊断为克罗恩病的患者中，肛门直肠疾病的手术干预更多。
