Department of Paediatric Surgery, The Royal Children's Hospital, 50 Flemington Road, Parkville, VIC 3052, Australia; Surgical Research, Murdoch Children's Research Institute, 50 Flemington Road, Parkville, VIC 3052, Australia; Department of Paediatrics, University of Melbourne, Parkville, VIC 3010, Australia; The University of Edinburgh, The Royal College of Surgeons of Edinburgh, UK.
Department of Surgery, The Royal Melbourne Hospital, 300 Grattan St, Parkville, VIC 3050, Australia.
J Pediatr Surg. 2019 Jul;54(7):1324-1330. doi: 10.1016/j.jpedsurg.2018.08.050. Epub 2018 Sep 7.
Surgical management of adult ulcerative colitis (UC) is well-studied, but not readily applicable to children. Restorative proctocolectomy with ileal pouch-anal anastomosis (RPC-IPAA), performed as one-, two-, or three-stage procedure, is preferred in pediatric patients with adequate anal sphincter function.
METHODS: Systematic review of Cochrane Register of Controlled Trials, PubMed, and EMBASE databases was conducted (January 1987-December 2016), in accordance with PRISMA.
Twelve retrospective studies were identified (568 patients total); 31, 334, and 203 patients underwent one-, two-, and three-stage procedures, respectively. Median study size was 31 patients (range 10-202), median age was 13 years (range 2-21), median follow-up was 4 years (range 0.08-16). Postoperative complications included pouchitis, bowel obstruction, stricture, fistula, pouch failure, anastomotic leak, and wound infections. Calcineurin inhibitor usage improved pediatric ulcerative colitis activity index (PUCAI) score. Higher PUCAI scores correlated with likelihood of staged procedures. Number of stages did not restrict quality of life.
Paucity of data exists, comparing preoperative factors leading to staged procedures in pediatric UC. This systematic review identifies an area for future studies.
II.
成人溃疡性结肠炎（UC）的手术治疗已有大量研究，但并不适用于儿童。对于具有足够肛门括约肌功能的儿科患者，首选直肠结肠切除加回肠储袋肛管吻合术（RPC-IPAA），可作为一期、二期或三期手术。
方法：按照 PRISMA 原则，对 Cochrane 对照试验注册库、PubMed 和 EMBASE 数据库进行系统评价。
共确定了 12 项回顾性研究（共 568 例患者）；分别有 31、334 和 203 例患者接受了一期、二期和三期手术。研究规模中位数为 31 例（范围 10-202 例），中位年龄为 13 岁（范围 2-21 岁），中位随访时间为 4 年（范围 0.08-16 年）。术后并发症包括储袋炎、肠梗阻、狭窄、瘘管、储袋功能障碍、吻合口漏和伤口感染。钙调磷酸酶抑制剂的使用改善了儿童溃疡性结肠炎活动指数（PUCAI）评分。更高的 PUCAI 评分与分期手术的可能性相关。分期手术的数量并不限制生活质量。
关于儿童 UC 导致分期手术的术前因素，目前的数据很少。本系统评价确定了未来研究的一个领域。
II 级。
