Department of Pediatrics, University of Calgary, Calgary, Canada.
J Pediatr Gastroenterol Nutr. 2012 Jun;54(6):763-8. doi: 10.1097/MPG.0b013e318245265c.
Colectomy rates for ulcerative colitis (UC) and data on postcolectomy complications in children are limited. Thus, we assessed colectomy rates, early postcolectomy complications, and clinical predictors in children with UC undergoing a colectomy.
Children (18 years old or older) with UC who underwent colectomy from 1983 to 2009 were identified (n=30). All of the medical charts were reviewed. The diagnostic accuracy of International Classification of Diseases codes for UC and colectomy were validated. The primary outcome was postoperative complications defined as Clavien-Dindo classification grade II or higher. The yearly incidence of colectomies for pediatric UC was calculated and temporal trends were evaluated.
The sensitivity and positive predictive value of UC and colectomy International Classification of Diseases codes were 96% and 100%, respectively. The median ages at UC diagnosis and colectomy were 10.9 and 12.1 years, respectively. All of the children had pancolitis and 63% underwent emergent colectomy. Postoperatively, 33% experienced at least 1 complication. Patients with emergent colectomy were more likely to have a postoperative complication compared with patients with elective colectomy (90% vs 50%; P=0.03). For emergent colectomy, postoperative complications were associated with a disease flare of ≥2 weeks before admission (60% vs 0%; P=0.03) and >2 weeks from admission to colectomy (78% vs 22%; P=0.04). The average annual rate of pediatric colectomy was 0.059/100,000 person-years and stable from 1983 to 2009 (P>0.05).
Colectomy UC was uncommon and rates have remained stable. Postcolectomy complications were common, especially in patients undergoing emergent colectomy. Optimizing timing of colectomy may reduce postoperative complications.
溃疡性结肠炎（UC）的结肠切除术率以及儿童术后并发症的数据十分有限。因此，我们评估了接受结肠切除术的儿童 UC 的结肠切除术率、早期术后并发症和临床预测因子。
1983 年至 2009 年间，我们确定了接受结肠切除术的儿童（18 岁或以上）UC 患者（n=30）。回顾了所有病历。验证了国际疾病分类代码对 UC 和结肠切除术的诊断准确性。主要结局为术后并发症，定义为 Clavien-Dindo 分级 II 级或更高。计算了每年儿童 UC 的结肠切除术发生率，并评估了时间趋势。
UC 和结肠切除术国际疾病分类代码的敏感性和阳性预测值分别为 96%和 100%。UC 诊断和结肠切除术的中位年龄分别为 10.9 岁和 12.1 岁。所有患儿均患有全结肠炎，63%的患儿行急诊结肠切除术。术后，33%的患儿至少出现 1 种并发症。与择期结肠切除术相比，急诊结肠切除术的患者更有可能发生术后并发症（90%比 50%；P=0.03）。对于急诊结肠切除术，术后并发症与入院前 2 周以上的疾病发作（60%比 0%；P=0.03）和入院至结肠切除术的时间超过 2 周（78%比 22%；P=0.04）有关。儿童结肠切除术的平均年发生率为 0.059/100,000 人年，且自 1983 年至 2009 年稳定（P>0.05）。
UC 的结肠切除术并不常见，且其比率保持稳定。结肠切除术后的并发症很常见，尤其是在接受急诊结肠切除术的患者中。优化结肠切除术的时机可能会减少术后并发症。
