Polites Stephanie F, Potter Donald D, Moir Christopher R, Zarroug Abdalla E, Stephens Michael C, Tung Jeanne, Pavey Emily S, Harmsen W Scott, Pemberton John H
Department of Surgery, Mayo Clinic, Rochester, Minnesota.
Division of Pediatric Surgery, University of Iowa Children's Hospital, University of Iowa, Iowa City, IA.
J Pediatr Surg. 2015 Oct;50(10):1625-9. doi: 10.1016/j.jpedsurg.2015.03.044. Epub 2015 Mar 26.
Ileal pouch-anal anastomosis (IPAA) is the surgical treatment of choice for patients with chronic ulcerative colitis (CUC). In the pediatric population, short-term outcomes of IPAA are excellent but long-term data limited. The purpose of this study is to report long-term functional and quality of life outcomes of IPAA in pediatric patients.
Functional outcomes and quality of life (QoL) following IPAA in patients ≤ 18 years of age were prospectively assessed by survey over a 30 year period. Preoperative information, chronic pouchitis and pouch loss were retrospectively reviewed.
Over 30 years, 202 children with CUC underwent IPAA. Questionnaires were returned by 87% and median (range) survey follow-up was 181.5 (7.8-378.5) months. Postoperative day and night-time stool frequency did not increase over time though incontinence increased slightly. Quality of life (QoL) was generally excellent and stable over time. Crohn's disease (CD) was diagnosed in 33 (16%) patients during the follow-up period. Chronic pouchitis occurred in 22 patients and pouch failure in 13 patients. Kaplan Meier estimates of pouch survival at 20 years were 61% for patients with CD and 92% for CUC.
Ileal pouch-anal anastomosis has long-term durability as a cure for pediatric chronic ulcerative colitis, with most patients reporting stable bowel function and QoL. Chronic pouchitis and pouch failure affect a minority of patients and require further study.
回肠储袋肛管吻合术（IPAA）是慢性溃疡性结肠炎（CUC）患者的首选手术治疗方法。在儿科患者中，IPAA的短期疗效极佳，但长期数据有限。本研究的目的是报告儿科患者IPAA的长期功能和生活质量结果。
通过为期30年的调查对18岁及以下患者IPAA后的功能结果和生活质量（QoL）进行前瞻性评估。对术前信息、慢性储袋炎和储袋丢失情况进行回顾性分析。
在30年期间，202例CUC患儿接受了IPAA。问卷回复率为87%，调查随访的中位时间（范围）为181.5（7.8 - 378.5）个月。术后白天和夜间排便次数未随时间增加，尽管失禁情况略有增加。生活质量（QoL）总体良好且随时间保持稳定。随访期间33例（16%）患者被诊断为克罗恩病（CD）。22例患者发生慢性储袋炎，13例患者储袋功能衰竭。CD患者20年储袋生存率的Kaplan Meier估计值为61%，CUC患者为92%。
回肠储袋肛管吻合术作为治疗小儿慢性溃疡性结肠炎具有长期疗效，大多数患者报告肠道功能和生活质量稳定。慢性储袋炎和储袋功能衰竭影响少数患者，需要进一步研究。
