Lourenço Rita, Azevedo Sara, Lopes Ana Isabel
Pediatric Department, Hospital do Divino Espírito Santo de Ponta Delgada, Azores, Portugal.
Gastroenterology Unit, Pediatric Department, Hospital de Santa Maria, Centro Hospitalar Lisboa Norte, Lisbon, Portugal.
GE Port J Gastroenterol. 2016 Jun 21;23(4):191-196. doi: 10.1016/j.jpge.2016.03.007. eCollection 2016 Jul-Aug.
There is a recognized increase of lifelong surgery risk in Crohn disease (CD). Outcome data concerning surgery in children, particularly in the biological era, are limited.
To characterize the clinical profile and the clinical outcome in children and adolescents with CD who underwent surgical intervention, in a single tertiary referral center.
Retrospective, cross-sectional study, including pediatric patients with CD undergoing intra-abdominal surgery in the last 11 years.
Included eight of 50 CD total patients (16%); six female; median age at CD diagnosis of 12.0 years; Paris classification: (a) location: ileocolonic (5), colonic (1), upper disease (1), ileocolonic/upper disease (1); (b) behavior: stricturing (4), nonstricturing nonpenetrating (2), penetrating (1), both penetrating and stricturing disease (1); growth delay (2). Six children received thiopurines, five mesalazine, three corticosteroids and four anti-TNF therapy, preoperatively. Surgery followed diagnosis by a median of 2.9 years. Median PCDAI at the time of surgery was 35.0. Elective surgery was performed in six patients and emergency surgery in two, without major complications. Five children received anti-TNF and three thiopurines post-operatively. Within the follow-up period (median 1.7 years), relapse occurred in one child (3.2 years after intervention); the remaining seven patients persist in clinical remission. Median PCDAI in the last evaluation was 6.3. Weight and height recovery was observed in seven patients, at last follow-up.
Surgical treatment of CD is a valid alternative in selected cases, contributing to the resolution of acute complications and maintenance of remission, allowing disease-free interval and nutritional recovery.
克罗恩病（CD）患者终身手术风险有公认的增加。关于儿童手术的结果数据有限，尤其是在生物制剂时代。
在一家单一的三级转诊中心，描述接受手术干预的儿童和青少年CD患者的临床特征及临床结局。
回顾性横断面研究，纳入过去11年接受腹部手术的CD儿科患者。
50例CD患者中有8例（16%）纳入研究；6例女性；CD诊断时的中位年龄为12.0岁；巴黎分类：（a）部位：回结肠型（5例）、结肠型（1例）、上消化道型（1例）、回结肠/上消化道型（1例）；（b）行为：狭窄型（4例）、非狭窄非穿透型（2例）、穿透型（1例）、穿透兼狭窄型（1例）；生长发育迟缓（2例）。6例儿童术前接受硫唑嘌呤治疗，5例接受美沙拉嗪治疗，3例接受皮质类固醇治疗，4例接受抗TNF治疗。手术在诊断后中位2.9年进行。手术时的中位PCDAI为35.0。6例行择期手术，2例行急诊手术，无重大并发症。5例儿童术后接受抗TNF治疗，3例接受硫唑嘌呤治疗。在随访期（中位1.7年）内，1例儿童复发（干预后3.2年）；其余7例患者持续临床缓解。末次评估时的中位PCDAI为6.3。末次随访时，7例患者体重和身高恢复。
对于特定病例，CD的手术治疗是一种有效的选择，有助于解决急性并发症并维持缓解，实现无病间期和营养恢复。
