Department of Surgery, Children's Hospital Boston, Harvard Medical School, Boston, MA, USA.
J Pediatr Surg. 2013 Jul;48(7):1540-5. doi: 10.1016/j.jpedsurg.2013.03.006.
The primary purpose of this study was to investigate the relationship between Pediatric Ulcerative Colitis Activity Index (PUCAI) and operative management. We also specifically evaluated those patients receiving tacrolimus for their disease.
A retrospective review (1/06-1/11) identified ulcerative colitis patients (≤21 years old) undergoing restorative proctocolectomy with rectal mucosectomy and ileal pouch-anal anastomosis. Main outcomes included pre-operative PUCAI, combined versus staged procedure, and postoperative complications. Patients receiving tacrolimus within 3 months of surgical intervention were identified. PUCAI at tacrolimus induction and medication side effects were also noted.
Sixty patients were identified. Forty-two (70%) underwent combined and 18 (30%) had staged procedures. Pre-operative PUCAI was lower for combined versus staged patients (p = < 0.001). Furthermore, a higher pre-operative PUCAI strongly correlated with the likelihood of undergoing a staged procedure (p < 0.001). Forty-four patients (73%) received tacrolimus. Significant improvement in their PUCAI was noted from induction to pre-operative evaluation (p < 0.001). Minor and reversible side effects occurred in 46% of patients receiving tacrolimus, but complication rates were not significantly different.
There is a very strong correlation between the PUCAI and the likelihood of undergoing a staged procedure. A significant improvement in PUCAI occurs following preoperative tacrolimus therapy.
本研究的主要目的是探讨小儿溃疡性结肠炎活动指数（PUCAI）与手术治疗的关系。我们还特别评估了那些接受他克莫司治疗的患者。
回顾性分析（2006 年 1 月至 2011 年 1 月）确定接受直肠黏膜切除术和回肠袋肛管吻合术的溃疡性结肠炎患者（≤21 岁）。主要结果包括术前 PUCAI、联合手术与分期手术以及术后并发症。确定在手术干预后 3 个月内接受他克莫司治疗的患者。还记录了他克莫司诱导时的 PUCAI 和药物副作用。
共确定了 60 例患者。42 例（70%）接受联合手术，18 例（30%）接受分期手术。联合手术组患者的术前 PUCAI 低于分期手术组（p < 0.001）。此外，较高的术前 PUCAI 与分期手术的可能性呈强烈相关性（p < 0.001）。44 例（73%）患者接受他克莫司治疗。从诱导期到术前评估，他们的 PUCAI 显著改善（p < 0.001）。接受他克莫司治疗的患者中有 46%出现轻微且可逆的副作用，但并发症发生率无显著差异。
PUCAI 与分期手术的可能性之间存在很强的相关性。术前接受他克莫司治疗后，PUCAI 显著改善。
