Shannon Angela, Eng Katharine, Kay Marsha, Blanchard Samra, Wyllie Robert, Mahajan Lori, Worley Sarah, Lavery Ian, Fazio Victor
Department of Pediatric Gastroenterology, Cleveland Clinic, Cleveland, OH.
University of Maryland Children's Hospital, Baltimore, MD.
J Pediatr Surg. 2016 Jul;51(7):1181-6. doi: 10.1016/j.jpedsurg.2015.12.012. Epub 2016 Jan 8.
The study's aim is to determine long-term outcomes in a large cohort of pediatric and young adult patients who underwent proctocolectomy with ileal pouch anal anastomsis (IPAA) for ulcerative colitis (UC).
Patients diagnosed with UC in childhood or adolescence (age≤21years) who underwent IPAA in childhood, adolescence, or young adulthood between 1982 and 1997 were contacted to determine pouch history, complications, and quality of life.
Data were obtained from 74 patients out of a previously reported cohort. Median age at diagnosis of UC was 15years and at surgery was 18years. Median follow-up was 20years. Complications during follow-up were pouchitis (45%), strictures (16%), fistulae (30%), obstruction (20%), and change of diagnosis to Crohn's (28%). Twenty-three percent reported no complications. Fourteen percent had pouch failure, with Crohn's and fistulae reported to be the most frequent complications. Seventy-nine percent reported being very satisfied at 20years follow-up.
To our knowledge, this study represents the largest cohort with the longest follow-up of pediatric and young adult patients undergoing IPAA for UC. Change in diagnosis to Crohn's and development of fistulae are risk factors for pouch failure. Despite reported complications, IPAA remains an excellent option for pediatric patients with UC.
本研究旨在确定一大群因溃疡性结肠炎（UC）接受回肠储袋肛管吻合术（IPAA）的儿科和青年患者的长期预后。
联系1982年至1997年间在儿童期、青春期或青年期接受IPAA手术的儿童期或青春期（年龄≤21岁）被诊断为UC的患者，以确定储袋病史、并发症和生活质量。
从先前报告队列中的74名患者获得数据。UC诊断时的中位年龄为15岁，手术时为18岁。中位随访时间为20年。随访期间的并发症包括袋炎（45%）、狭窄（16%）、瘘管（30%）、梗阻（20%）以及诊断变更为克罗恩病（28%）。23%的患者报告无并发症。14%的患者出现储袋功能衰竭，其中克罗恩病和瘘管被报告为最常见的并发症。79%的患者在20年随访时报告非常满意。
据我们所知，本研究是接受IPAA治疗UC的儿科和青年患者中随访时间最长的最大队列研究。诊断变更为克罗恩病和瘘管形成是储袋功能衰竭的危险因素。尽管有并发症报告，但IPAA仍然是儿科UC患者的一个极佳选择。
