Kantor Navot, Wayne Carolyn, Nasr Ahmed
Department of Surgery, Children's Hospital of Eastern Ontario, 401 Smyth Rd, Ottawa, ON, K1H 8L1, Canada.
Faculty of Medicine, University of Ottawa, 451 Smyth Rd, Ottawa, ON, K1H 8L1, Canada.
Pediatr Surg Int. 2017 May;33(5):551-557. doi: 10.1007/s00383-017-4067-6. Epub 2017 Jan 30.
Perianal fistulous disease is present in 10-15% of children with Crohn's disease (CD) and is frequently complex and refractory to treatment, with one-third of patients having recurrent lesions. We conducted a systematic review of the literature to examine the best surgical strategy or strategies for pediatric complex perianal fistulous disease (CPFD) in CD.
We searched CENTRAL, MEDLINE, EMBASE, and CINAHL for studies discussing at least one surgical strategy for the treatment of pediatric CPFD in CD. Reference lists of included studies were hand-searched. Two researchers screened all studies for inclusion, quality assessed each relevant study, and extracted data.
One non-randomized prospective and two retrospective studies met our inclusion criteria. Combined use of setons and infliximab therapy shows promise as a first-line treatment. A specific form of fistulectomy, "cone-like resection," also shows promise when combined with biologics. Endoscopic ultrasound to guide medical and surgical management is feasible in the pediatric population, though it is unclear if it improves outcomes.
There is a paucity of evidence regarding the treatment of CPFD in the pediatric population, and further research is required before recommendations can be made as to what, if any, surgical management is optimal.
肛周瘘管病见于10% - 15%的克罗恩病（CD）患儿，常病情复杂且治疗棘手，三分之一的患者会出现病变复发。我们对文献进行了系统综述，以探究治疗CD患儿复杂性肛周瘘管病（CPFD）的最佳手术策略。
我们检索了Cochrane系统评价数据库、医学期刊数据库、荷兰医学文摘数据库和护理学与健康领域数据库，查找讨论至少一种治疗CD患儿CPFD手术策略的研究。对纳入研究的参考文献列表进行手工检索。两名研究人员筛选所有研究以确定是否纳入，对每项相关研究进行质量评估并提取数据。
一项非随机前瞻性研究和两项回顾性研究符合我们的纳入标准。挂线疗法与英夫利昔单抗联合治疗有望成为一线治疗方法。一种特殊形式的瘘管切除术，即“锥形切除术”，与生物制剂联合使用时也显示出前景。内镜超声引导药物和手术治疗在儿科人群中是可行的，不过其是否能改善治疗效果尚不清楚。
关于儿科人群CPFD治疗的证据不足，在就何种手术管理（若有）为最佳做出推荐之前，还需要进一步研究。
