Diederen Kay, de Ridder Lissy, van Rheenen Patrick, Wolters Victorien M, Mearin Maria L, Damen Gerard M, de Meij Tim G, van Wering Herbert, Tseng Laura A, Oomen Matthijs W, de Jong Justin R, Sloots Cornelius E, Benninga Marc A, Kindermann Angelika
*Department of Pediatric Gastroenterology and Nutrition, Emma Children's Hospital, Academic Medical Center, Amsterdam, the Netherlands; †Department of Pediatric Gastroenterology, Erasmus MC-Sophia Children's Hospital, Rotterdam, the Netherlands; ‡Department of Pediatric Gastroenterology, University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands; §Department of Pediatric Gastroenterology, University Medical Center Utrecht, Utrecht, the Netherlands; ‖Department of Pediatrics, Leiden University Medical Center, Leiden, the Netherlands; ¶Department of Pediatric Gastroenterology, Radboud University Medical Center, Nijmegen, the Netherlands; **Department of Pediatric Gastroenterology, VU University Medical Center, Amsterdam, the Netherlands; ††Department of Pediatrics, Amphia Hospital, Breda, the Netherlands; ‡‡Department of Pediatric Surgery, Academic Medical Center, Amsterdam, the Netherlands; and §§Department of Pediatric Surgery, Erasmus MC-Sophia Children's Hospital, Rotterdam, the Netherlands.
Inflamm Bowel Dis. 2017 Feb;23(2):272-282. doi: 10.1097/MIB.0000000000000999.
Studies on the outcome of ileocecal resection in pediatric Crohn's disease (CD) have a limited follow-up and fail to assign predictors of adverse outcomes. Therefore, we aimed to investigate (I) the complication and disease recurrence rates and (II) identify risk factors for these adverse outcomes after ileocecal resection for pediatric CD.
This is a retrospective cohort analysis of all children (<18 years) that underwent ileocecal resection as first intestinal resection for CD derived from 7 tertiary hospitals in the Netherlands (1990-2015). Risk factors were identified using multivariable analysis.
In total, 122 children were included (52% male; median age 15.5 years [interquartile range 14.0-16.0]). Severe postoperative complications rate was 10%. Colonic disease (odds ratio: 5.6 [95% confidence interval {CI}: 1.3-26.3], P = 0.024), microscopically positive resection margins (odds ratio: 10.4 [95% CI: 1.1-100.8] P = 0.043), and emergency surgery (odds ratio: 6.8 [95% CI: 1.1-42.2], P = 0.038) were risk factors for severe complications. Clinical and surgical recurrence rates after 1, 5 and 10 years were 19%, 49%, 71% and 2%, 12%, 22%, respectively. Female sex (hazard ratio [HR]: 2.1 [95% CI: 1.1-3.8], P = 0.023) was a risk factor for clinical recurrence, whereas ileocecal disease (HR: 3.9 [95% CI: 1.2-12.5], P = 0.024) and microscopically positive resection margins (HR: 9.6 [95% CI: 1.2-74.5], P = 0.031) were risk factors for surgical recurrence. Immediate postoperative therapy reduced the risk of both clinical (HR: 0.3 [95% CI: 0.1-0.6], P = 0.001) and surgical (HR: 0.5 [95% CI: 0.1-0.9], P = 0.035) recurrence.
Ileocecal resection is an effective and durable treatment of pediatric CD, although postoperative complications occur frequently. Postoperative therapy may be started immediately to prevent disease recurrence.
关于小儿克罗恩病（CD）回盲部切除术结局的研究随访期有限，且未明确不良结局的预测因素。因此，我们旨在调查（I）并发症和疾病复发率，以及（II）确定小儿CD回盲部切除术后这些不良结局的危险因素。
这是一项对荷兰7家三级医院（1990 - 2015年）所有因CD首次接受肠道切除术而行回盲部切除术的儿童（<18岁）进行的回顾性队列分析。采用多变量分析确定危险因素。
共纳入122名儿童（52%为男性；中位年龄15.5岁[四分位间距14.0 - 16.0]）。术后严重并发症发生率为10%。结肠疾病（比值比：5.6[95%置信区间{CI}：1.3 - 26.3]，P = 0.024）、显微镜下切缘阳性（比值比：10.4[95% CI：1.1 - 100.8]，P = 0.043）和急诊手术（比值比：6.8[95% CI：1.1 - 42.2]，P = 0.038）是严重并发症的危险因素。1年、5年和10年后的临床复发率和手术复发率分别为19%、49%、71%和2%、12%、22%。女性（风险比[HR]：2.1[95% CI：1.1 - 3.8]，P = 0.023）是临床复发的危险因素，而回盲部疾病（HR：3.9[95% CI：1.2 - 12.5]，P = 0.024）和显微镜下切缘阳性（HR：9.6[95% CI：1.2 - 74.5]，P = 0.031）是手术复发的危险因素。术后立即治疗降低了临床（HR：0.3[95% CI：0.1 - 0.6]，P = 0.001）和手术（HR：0.5[95% CI：0.1 - 0.9]，P = 0.035）复发的风险。
回盲部切除术是治疗小儿CD的一种有效且持久的方法，尽管术后并发症频繁发生。术后可立即开始治疗以预防疾病复发。
