Department of Paediatric Surgery, The Royal Children's Hospital, Parkville, Victoria, Australia; The University of Edinburgh, The Royal College of Surgeons of Edinburgh, UK; Surgical Research, Murdoch Children's Research Institute, Parkville, Victoria, Australia.
Department of Paediatric Surgery, The Royal Children's Hospital, Parkville, Victoria, Australia; Surgical Research, Murdoch Children's Research Institute, Parkville, Victoria, Australia; Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia.
J Pediatr Surg. 2019 Dec;54(12):2554-2558. doi: 10.1016/j.jpedsurg.2019.08.036. Epub 2019 Oct 15.
The timely management of pediatric Crohn's disease (CD), and specifically perianal CD, is important owing to the possible adverse effects on growth, development, and quality of life. Perianal involvement is increasingly common, with up to 62% of pediatric CD patients affected. Presently, literature addressing the management of perianal CD has focused primarily on adults, with findings that cannot always be extrapolated to the pediatric population. We aimed to review the rates of healing, recurrence, and need for surgical intervention in perianal CD to provide evidence-based recommendations for the ideal management in children.
We conducted a systematic review of CENTRAL, PubMed, Medline, and EMBASE databases (January 1997-December 2017) in accordance with PRISMA. Two independent reviewers performed data extraction.
Ten studies met the inclusion criteria with a combined total of 538 patients. Median study population size was 17 (range 7-276), with a median age at intervention of 13.9 years (range 1-18). Seton placement allowed complete healing in 28.6% of children. Similar results (28.5%) were seen in children undergoing fecal diversion. One study demonstrated complete resolution of fistulizing disease in 70% of children treated with infliximab (IFX). One quarter of patients treated with IFX required further surgical intervention for disease control. Recurrence occurred most frequently in children undergoing Seton placement alone (5/14, 35.7%), compared with IFX (46/197, 23.4%) and combination therapy (12/276, 4.3%).
In the pediatric population, a combination of medical and surgical treatment is required to control perianal CD, with fewer side effects.
Level II.
儿童克罗恩病（CD），尤其是肛周 CD 的及时治疗非常重要，因为它可能会对生长、发育和生活质量产生不良影响。肛周病变的发病率逐渐增高，高达 62%的儿童 CD 患者受其影响。目前，有关肛周 CD 管理的文献主要集中在成年人，研究结果不能总是外推到儿科人群。我们旨在回顾肛周 CD 的愈合、复发和手术干预的发生率，为儿童提供肛周 CD 理想管理的循证推荐。
我们按照 PRISMA 进行了系统评价，对 CENTRAL、PubMed、Medline 和 EMBASE 数据库（1997 年 1 月至 2017 年 12 月）进行了检索。两名独立的审查员进行了数据提取。
10 项研究符合纳入标准，共纳入 538 例患者。研究人群的中位数为 17 岁（范围 7-276 岁），干预时的中位数年龄为 13.9 岁（范围 1-18 岁）。放置引流管可使 28.6%的儿童完全愈合。粪便分流术的结果相似（28.5%）。一项研究表明，接受英夫利昔单抗（IFX）治疗的儿童中，70%的瘘管性疾病完全缓解。四分之一接受 IFX 治疗的患者需要进一步手术干预以控制疾病。单独放置引流管的儿童（5/14，35.7%）复发率最高，而接受 IFX（46/197，23.4%）和联合治疗（12/276，4.3%）的儿童复发率较低。
在儿科人群中，需要联合使用药物和手术治疗来控制肛周 CD，且副作用更少。
Ⅱ级。
