Division of Pediatric Surgery, Mayo Clinic, Rochester, MN.
Division of Pediatric Surgery, Mayo Clinic, Rochester, MN.
J Pediatr Surg. 2020 Jan;55(1):59-62. doi: 10.1016/j.jpedsurg.2019.09.051. Epub 2019 Oct 24.
Ileal Pouch-Anal Anastomosis (IPAA) is the standard of care for children requiring surgical treatment of severe colitis or polyposis syndromes. This study aims is to investigate the sexual function and fertility in women after undergoing childhood IPAA.
A prospectively maintained colon and rectal database of consenting patients was queried from January 1980 to October 2015. We included all females that replied to at least 1 survey between the ages of 20 and 45 years that had undergone IPAA younger than 20 years of age.
Two hundred females met inclusion criteria, whereas 149 women replied to the sexual function questions. Ulcerative colitis was diagnosed in 122 (83%) patients, with the remainder having polyposis. Seven patients had a laparoscopic proctectomy. Only 2 patients had a pelvic infection, whereas 21 had intestinal obstruction postoperatively. A severely restricted sex life was reported in 6 (5%) patients. Of the 93 (62%) women who attempted pregnancy, 68 (73%) became pregnant. Median age of pregnancy and IPAA was 34 (range 22-45) and 17 years (range 9-20), respectively. Medical intervention to assist fertilization was required in 14/68. A total of 29 women reported problems during pregnancy with 58/68 (88%) giving birth to a live baby. Elective termination was reported in 2/68 surveys. Vaginal delivery occurred in 26/58 mothers with 27/58 planned and 9/58 unplanned cesarean sections. Age at IPAA, diagnosis, procedure type, pelvic infection, and obstruction were not associated with decreased fertility. All 7 patients operated laparoscopically have become pregnant. Change in pouch function after delivery was reported in 20/68 (32%, 5 missing) surveys.
73% of women who desired children become pregnant, and 88% had a successful delivery after pediatric IPAA. Only 5% reported severely restricted sexual function. Changes in pouch function occurred with pregnancy and persisted in 1/3 after delivery. Minimally invasive techniques may improve fertility rates but equire continued follow-up.
Level IV.
Observational study.
回肠贮袋肛管吻合术（IPAA）是治疗儿童重度结肠炎或息肉病综合征的标准治疗方法。本研究旨在探讨接受儿童期 IPAA 后女性的性功能和生育能力。
从 1980 年 1 月至 2015 年 10 月，前瞻性维护了一个同意患者的结肠和直肠数据库。我们纳入了所有年龄在 20 至 45 岁之间、20 岁以下接受 IPAA 治疗且至少回复了 1 份调查问卷的女性。
200 名女性符合纳入标准，其中 149 名女性回复了性功能问题的调查问卷。122 名（83%）患者诊断为溃疡性结肠炎，其余患者患有息肉病。7 名患者行腹腔镜直肠切除术。仅 2 例患者发生盆腔感染，21 例患者术后发生肠梗阻。6 名（5%）患者报告性生活严重受限。在 93 名（62%）试图怀孕的女性中，68 名（73%）怀孕。怀孕和 IPAA 的中位年龄分别为 34 岁（范围 22-45 岁）和 17 岁（范围 9-20 岁）。14/68 名需要医疗干预辅助受精。29 名女性报告在怀孕期间出现问题，68/68 名（88%）分娩活产婴儿。2/68 名调查中报告选择性终止妊娠。26/58 名母亲经阴道分娩，27/58 名计划剖宫产，9/58 名意外剖宫产。IPAA 年龄、诊断、手术类型、盆腔感染和梗阻与生育能力下降无关。所有 7 名接受腹腔镜手术的患者均已怀孕。68 份调查问卷中有 20 份（5 份缺失）报告了储袋功能在分娩后发生变化。
73%希望生育孩子的女性怀孕，儿童期 IPAA 后 88%成功分娩。仅有 5%的女性报告严重限制了性功能。怀孕后储袋功能发生变化，1/3 患者在分娩后仍持续存在。微创技术可能提高生育能力，但需要持续随访。
IV 级
观察性研究
