Splawski Judy B, Pffefferkorn Marian D, Schaefer Marc E, Day Andrew S, Soldes Oliver S, Ponsky Todd A, Stein Philip, Kaplan Jess L, Saeed Shehzad A
*Pediatric Gastroenterology, Hepatology and Nutrition, University Hospitals Rainbow Babies and Children's Hospital, Cleveland, OH †Pediatric Gastroenterology, Hepatology and Nutrition, Indiana University School of Medicine, Riley Children's Hospital, Indianapolis, IN ‡Pediatric Gastroenterology and Nutrition, Penn State Hershey Children's Hospital, Penn State Milton S. Hershey Medical Center, Hershey, PA §Paediatrics, University of Otago (Christchurch), Christchurch, New Zealand ||Pediatric Surgery, Akron Children's Hospital, Akron, OH ¶Pediatric Gastroenterology, Hepatology and Nutrition, St. Christopher's Hospital for Children, Philadelphia, PA #Pediatric Gastroenterology and Nutrition, MassGeneral Hospital for Children, Boston, MA **Gastroenterology Hepatology and Nutrition, Cincinnati Children's Hospital Medical Center, Cincinnati, OH.
J Pediatr Gastroenterol Nutr. 2017 Oct;65(4):475-486. doi: 10.1097/MPG.0000000000001606.
Pediatric Crohn disease is characterized by clinical and endoscopic relapses. The inflammatory process is considered to be progressive and may lead to strictures, fistulas, and penetrating disease that may require surgery. In addition, medically refractory disease may be treated by surgical resection of inflamed bowel in an effort to reverse growth failure. The need for surgery in childhood suggests severe disease and these patients have an increased risk for recurrent disease and potentially more surgery. Data show that up to 55% of patients had clinical recurrence in the first 2 years after initial surgery. The current clinical report on postoperative recurrence in pediatric Crohn disease reviews the risk factors for early surgery and postoperative recurrence, operative risk factors for recurrence, and prevention and monitoring strategies for postoperative recurrence. We also propose an algorithm for postoperative management in pediatric Crohn disease.
儿童克罗恩病的特点是临床和内镜下复发。炎症过程被认为是进行性的，可能导致狭窄、瘘管和穿透性疾病，可能需要手术治疗。此外，药物难治性疾病可通过手术切除发炎肠段来治疗，以扭转生长发育迟缓。儿童期需要手术提示病情严重，这些患者疾病复发风险增加，可能需要更多手术。数据显示，高达55%的患者在初次手术后的头两年出现临床复发。这份关于儿童克罗恩病术后复发的临床报告回顾了早期手术和术后复发的风险因素、复发的手术风险因素以及术后复发的预防和监测策略。我们还提出了儿童克罗恩病术后管理的算法。
