Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.
Center for Digestive Disease, Karolinska University Hospital, Stockholm, Sweden.
J Crohns Colitis. 2018 Jan 24;12(2):157-166. doi: 10.1093/ecco-jcc/jjx132.
The incidence of childhood-onset [< 18 years] inflammatory bowel disease [IBD] is increasing worldwide, and some studies suggest that it represents a more severe disease phenotype. Few nationwide, population-based studies have evaluated the surgical burden in patients with childhood-onset IBD, and whether the improved medical treatment has influenced the need for gastrointestinal surgery. The aim was to examine whether the surgical treatment at any age of patients with childhood-onset IBD has changed over time.
In a nationwide cohort study we identified 4695 children [< 18 years] diagnosed with incident IBD in 2002-2014 through the Swedish Patient Register [ulcerative colitis: n = 2295; Crohn's disease: n = 2174; inflammatory bowel disease-unclassified: n = 226]. Abdominal [intestinal resections and colectomies] and perianal surgeries were identified through the Swedish Patient Register. The cumulative incidences of surgeries were calculated using the Kaplan-Meier method.
In the cohort, 44% were females and 56% males. The median age at inflammatory bowel disease diagnosis was 15 years and the maximum age at end of follow-up was 31 years. The 3-year cumulative incidence of intestinal surgery was 5% in patients with ulcerative colitis and 7% in patients with Crohn's disease, and lower in children aged < 6 years at inflammatory bowel disease diagnosis [3%] than in those aged 15-17 years at diagnosis [7%]. Calendar period of inflammatory bowel disease diagnosis was not associated with risk of surgery.
Over the past 13 years, the risk of surgery in childhood-onset inflammatory bowel disease has remained unchanged.
全球范围内，儿童期发病（<18 岁）炎症性肠病（IBD）的发病率正在上升，一些研究表明其代表了更严重的疾病表型。很少有全国性、基于人群的研究评估了儿童期发病 IBD 患者的手术负担，以及改善的治疗方法是否影响了胃肠道手术的需求。本研究旨在检查儿童期发病 IBD 患者在任何年龄段的手术治疗是否随时间发生了变化。
在一项全国性队列研究中，我们通过瑞典患者登记处（Swedish Patient Register）确定了 2002-2014 年期间诊断为发病 IBD 的 4695 名儿童（<18 岁；溃疡性结肠炎：n=2295；克罗恩病：n=2174；未分类的炎症性肠病：n=226）。通过瑞典患者登记处确定腹部（肠道切除术和结肠切除术）和肛周手术。使用 Kaplan-Meier 方法计算手术的累积发生率。
在该队列中，44%为女性，56%为男性。IBD 诊断时的中位年龄为 15 岁，随访结束时的最大年龄为 31 岁。溃疡性结肠炎患者 3 年肠道手术的累积发生率为 5%，克罗恩病患者为 7%，而 IBD 诊断时年龄<6 岁的患者（3%）低于诊断时年龄 15-17 岁的患者（7%）。IBD 诊断的日历时间与手术风险无关。
在过去 13 年中，儿童期发病 IBD 的手术风险保持不变。
