Pini Prato Alessio, Pio Luca, Leonelli Lorenzo, Pistorio Angela, Crocco Marco, Arrigo Serena, Gandullia Paolo, Mazzola Cinzia, Sanfilippo Fabio, Barabino Arrigo, Mattioli Girolamo
*Department of Surgery, Istituto Giannina Gaslini †Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa ‡Epidemiology and Biostatistics Unit, Istituto Giannina Gaslini §Gastroenterology and Endoscopy Unit, Istituto Giannina Gaslini, Genoa, Italy.
J Pediatr Gastroenterol Nutr. 2016 Jun;62(6):858-62. doi: 10.1097/MPG.0000000000001025.
Laparoscopic-assisted ileostomy (LAI) represents a cornerstone for the staged approach to ulcerative colitis (UC). The aim is to determine stoma morbidity in a series of pediatric patients and possibly identify specific risk factors.
All of the patients who underwent LAI for UC between January 2008 and December 2014 were included. The following data were collected: patient demographics, preoperative medical treatment, body mass index (BMI) at surgery, Pediatric UC Index (PUCAI), and stoma-related complications. In this series of patients, a staged approach has been adopted (subtotal colectomy + ileostomy; restorative proctocolectomy with J-pouch ileo-rectal anastomosis + ileostomy; ileostomy closure).
Seventy-two LAIs were fashioned in 37 pediatric patients with UC. Median age at surgery was 12 years (range 5-14.8 years). Boy to girl ratio was 0.85:1. Mortality was zero. Complications occurred after 8 procedures after a median of 31 days postoperatively (range 8-60 days). Those were significantly more frequent in the case of BMI-z score >-0.51 (deleted in revised manuscript, ie, relatively overweight patients) and in the case of preoperative azathioprine administration. Pediatric UC Index score, sex, number of preoperative medications, and other preoperative parameters did not correlate with the incidence of complications.
Our study suggests to keep a prudent behavior in the case of patients with a BMI-z score >-0.51 and received preoperative azathioprine administration. Parents should be adequately acknowledged on this regard.
腹腔镜辅助回肠造口术（LAI）是溃疡性结肠炎（UC）分期治疗的基石。目的是确定一系列儿科患者的造口并发症发生率，并可能识别特定的风险因素。
纳入2008年1月至2014年12月期间因UC接受LAI的所有患者。收集以下数据：患者人口统计学资料、术前药物治疗、手术时的体重指数（BMI）、小儿UC指数（PUCAI）以及与造口相关的并发症。在这组患者中，采用了分期治疗方法（全结肠切除术+回肠造口术；J袋回肠直肠吻合术+回肠造口术的保留性直肠结肠切除术；回肠造口关闭术）。
37例患有UC的儿科患者共进行了72次LAI手术。手术时的中位年龄为12岁（范围5-14.8岁）。男女比例为0.85:1。死亡率为零。8例手术后出现并发症，术后中位时间为31天（范围8-60天）。在BMI-z评分＞-0.51（在修订稿件中删除，即相对超重患者）以及术前使用硫唑嘌呤的情况下，并发症明显更频繁。小儿UC指数评分、性别、术前用药数量以及其他术前参数与并发症发生率无关。
我们的研究表明，对于BMI-z评分＞-0.51且术前使用硫唑嘌呤的患者，应保持谨慎态度。在这方面应充分告知家长。
