Abbas Paulette I, Peterson Michelle L, Fallon Sara C, Lopez Monica E, Wesson David E, Walsh Seema M, Kellermayer Richard, Rodriguez J Ruben
Texas Children's Hospital, Baylor College of Medicine, Houston, Texas; The Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas.
Texas Children's Hospital, Baylor College of Medicine, Houston, Texas; Department of Pediatrics, Division of Gastroenterology, Hepatology, and Nutrition, Baylor College of Medicine, Houston, Texas.
J Pediatr Surg. 2016 May;51(5):786-9. doi: 10.1016/j.jpedsurg.2016.02.023. Epub 2016 Feb 14.
The impact of infliximab (IFX) on surgical outcomes is poorly defined in pediatric Crohn's disease (CD). We evaluated our institution's experience with IFX on postoperative complications and surgical recurrence.
A retrospective review of children who underwent intestinal resection with primary anastomosis for CD from 1/2002 to 10/2014 was performed. Data collected included IFX use and surgical outcomes. Preoperative IFX use was within 3months of surgery.
Seventy-three patients were included with median age 15years (range: 9-18). The most frequent indications for operation were obstruction (n=26) and fistulae (n=19). Nine patients (13%) had a surgical recurrence at a median of 2.3years (IQR 0.7-3.5). Twenty-two patients received preoperative IFX at median of 26days (IQR 14-46). There were 7 postoperative complications: 2 bowel obstructions, and 5 superficial wound infections. Outcomes of patients stratified by IFX were not different. When stratified by indication, refractory disease was associated with higher preoperative IFX use (IFX use 55% vs. no IFX use 28%, p=0.027). No specific indication was associated with increased reoperation rates.
Pediatric CD patients treated with preoperative IFX undergo intestinal resection with primary anastomosis with acceptable morbidity. The heterogeneous approach to medical management underscores the need for guidelines to direct treatment.
英夫利昔单抗（IFX）对小儿克罗恩病（CD）手术结局的影响尚不明确。我们评估了本机构使用IFX治疗术后并发症及手术复发情况的经验。
对2002年1月至2014年10月因CD行肠切除并一期吻合术的儿童进行回顾性研究。收集的数据包括IFX使用情况及手术结局。术前IFX使用时间在手术前3个月内。
纳入73例患者，中位年龄15岁（范围：9 - 18岁）。最常见的手术指征是肠梗阻（n = 26）和瘘管（n = 19）。9例患者（13%）出现手术复发，中位复发时间为2.3年（四分位间距0.7 - 3.5年）。22例患者术前接受IFX治疗，中位治疗时间为26天（四分位间距14 - 46天）。术后有7例并发症：2例肠梗阻和5例浅表伤口感染。按IFX分层的患者结局无差异。按手术指征分层时，难治性疾病与术前较高的IFX使用率相关（IFX使用率55% vs. 未使用IFX率28%，p = 0.027）。无特定指征与再次手术率增加相关。
术前接受IFX治疗的小儿CD患者行肠切除并一期吻合术，其发病率可接受。药物治疗方法的异质性凸显了制定治疗指南的必要性。
