Department of Pediatric Gastroenterology and Nutrition, Emma Children's Hospital, Academic Medical Center, Meibergdreef 9 (room C2-312), 1105 AZ, Amsterdam, The Netherlands.
Department of Pediatric Gastroenterology, Erasmus MC-Sophia Children's Hospital, Rotterdam, the Netherlands.
Eur J Pediatr. 2019 Sep;178(9):1413-1421. doi: 10.1007/s00431-019-03427-3. Epub 2019 Jul 20.
Psychosocial and functional outcomes after intestinal resection in pediatric Crohn's disease (CD) are lacking. Therefore, we (I) assessed health-related quality of life (HRQOL), colorectal function, and satisfaction with surgery and (II) investigated their relationship with surgical outcomes, after ileocecal resection for CD. Crohn's patients that underwent ileocecal resection during childhood were included. HRQOL and colorectal function were assessed using SF-36 and COREFO, respectively, and compared with reference values. Satisfaction was scored on a 5-point Likert scale. In total, 80 patients (50% male, median age 23.0 years) were included. Physical HRQOL was impaired (SF-36 [mean]: CD, 47 vs. general, 54; p < 0.001), while mental HRQOL was similar to that in the general population. Overall colorectal function was impaired (COREFO [mean]: CD, 12.6 vs. normal, 7.2; p < 0.001). Worse colorectal function was associated with increasing clinical disease activity and longer interval since resection. Majority of patients was satisfied with surgery (81% satisfied/very satisfied, 11% neither satisfied nor dissatisfied, 8% dissatisfied/very dissatisfied). Decreased satisfaction with surgery was associated with increased clinical disease activity but not related to colorectal function.Conclusions: Physical HRQOL and colorectal function in CD patients who underwent ileocecal resection during childhood seem impaired and related to adverse surgical outcomes. This emphasizes the need for post-operative monitoring and prophylactic therapies. What is Known: • Up to 25% of pediatric-onset Crohn's disease (CD) patients undergo an intestinal resection within 5 years from diagnosis. • Many children and adults with CD experience disruption of their daily activities and health-related quality of life (HRQOL). What is New: • Physical HRQOL and colorectal function are impaired in patient with CD that underwent ileocecal resection during childhood. • Increasing clinical disease activity, a longer interval since surgery, severe complications related to surgery, and recurrent surgeries are all associated with worse colorectal function.
儿科克罗恩病（CD）患者肠切除术后的心理社会和功能结果尚不清楚。因此，我们（I）评估了健康相关生活质量（HRQOL）、结直肠功能以及对手术的满意度，（II）并调查了它们与手术结果的关系，这些结果是通过回盲部切除术治疗 CD 获得的。纳入了儿童时期接受回盲部切除术的克罗恩病患者。使用 SF-36 和 COREFO 分别评估 HRQOL 和结直肠功能，并与参考值进行比较。满意度评分采用 5 分李克特量表。共纳入 80 例患者（50%为男性，中位年龄为 23.0 岁）。身体 HRQOL 受损（SF-36 [平均值]：CD，47 与一般人群，54；p<0.001），而心理 HRQOL 与一般人群相似。总体结直肠功能受损（COREFO [平均值]：CD，12.6 与正常，7.2；p<0.001）。结直肠功能越差，临床疾病活动度越高，切除后间隔时间越长。大多数患者对手术满意（81%满意/非常满意，11%既不满意也不不满意，8%不满意/非常不满意）。对手术的满意度降低与临床疾病活动度增加有关，但与结直肠功能无关。结论：在儿童时期接受回盲部切除术的 CD 患者中，身体 HRQOL 和结直肠功能似乎受损，并与不良的手术结果相关。这强调了术后监测和预防性治疗的必要性。已知：• 25%的儿童期发病的克罗恩病（CD）患者在诊断后 5 年内需要进行肠道切除术。• 许多患有 CD 的儿童和成人的日常活动和健康相关生活质量（HRQOL）都会受到影响。新内容：• 在儿童时期接受回盲部切除术的 CD 患者中，身体 HRQOL 和结直肠功能受损。• 临床疾病活动度增加、手术间隔时间延长、与手术相关的严重并发症以及反复手术均与结直肠功能恶化相关。
