Pugmire Brian S, Gee Michael S, Kaplan Jess L, Hahn Peter F, Doody Daniel P, Winter Harland S, Gervais Debra A
Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave., Cincinnati, OH, 45229, USA.
Department of Radiology, Massachusetts General Hospital for Children, Boston, MA, USA.
Pediatr Radiol. 2016 May;46(5):653-9. doi: 10.1007/s00247-015-3533-3. Epub 2016 Jan 29.
Intra-abdominal abscess is a common complication of Crohn disease in children. Prior studies, primarily in adults, have shown that percutaneous abscess drainage is a safe and effective treatment for this condition; however, the data regarding this procedure and indications in pediatric patients is limited.
Our aim was to determine the success rate of percutaneous abscess drainage for abscesses related to Crohn disease in pediatric patients with a focus on treatment endpoints that are relevant in the era of biological medical therapy.
We retrospectively reviewed 25 cases of patients ages ≤20 years with Crohn disease who underwent percutaneous abscess drainage. Technical success was defined as catheter placement within the abscess with reduction in abscess size on post-treatment imaging. Clinical success was defined as (1) no surgery within 1 year of drainage or (2) surgical resection following drainage with no residual abscess at surgery or on preoperative imaging. Multiple clinical parameters were analyzed for association with treatment success or failure.
All cases were classified as technical successes. Nineteen cases were classified as clinical successes (76%), including 7 patients (28%) who required no surgery within 1 year of percutaneous drainage and 12 patients (48%) who had elective bowel resection within 1 year. There was a statistically significant association between resumption of immunosuppressive therapy within 8 weeks of drainage and both clinical success (P < 0.01) and avoidance of surgery after 1 year (P < 0.01).
Percutaneous abscess drainage is an effective treatment for Crohn disease-related abscesses in pediatric patients. Early resumption of immunosuppressive therapy is statistically associated with both clinical success and avoidance of bowel resection, suggesting a role for percutaneous drainage in facilitating prompt initiation of medical therapy and preventing surgical bowel resection.
腹腔内脓肿是儿童克罗恩病的常见并发症。先前的研究主要针对成人，表明经皮脓肿引流是治疗该病症的一种安全有效的方法；然而，关于该手术及其在儿科患者中的适应症的数据有限。
我们的目的是确定儿科患者中与克罗恩病相关脓肿的经皮脓肿引流成功率，重点关注生物医学治疗时代相关的治疗终点。
我们回顾性分析了25例年龄≤20岁的克罗恩病患者，这些患者接受了经皮脓肿引流。技术成功定义为将导管置于脓肿内，且治疗后影像学检查显示脓肿大小缩小。临床成功定义为：（1）引流后1年内未进行手术；或（2）引流后进行手术切除，手术时或术前影像学检查无残留脓肿。分析了多个临床参数与治疗成功或失败的相关性。
所有病例均为技术成功。19例为临床成功（76%），其中7例（28%）经皮引流后1年内无需手术，12例（48%）在1年内接受了择期肠切除术。引流后8周内恢复免疫抑制治疗与临床成功（P＜0.01）及1年后避免手术（P＜0.01）之间存在统计学显著关联。
经皮脓肿引流是治疗儿科患者克罗恩病相关脓肿的有效方法。早期恢复免疫抑制治疗在统计学上与临床成功及避免肠切除相关，提示经皮引流在促进及时开始药物治疗和预防肠切除手术方面具有作用。
