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手术与小儿炎症性肠病

Surgery and paediatric inflammatory bowel disease.

作者信息

Kelay Arun, Tullie Lucinda, Stanton Michael

机构信息

Department of Paediatric Surgery, University Hospital Southampton, Southampton, UK.

出版信息

Transl Pediatr. 2019 Dec;8(5):436-448. doi: 10.21037/tp.2019.09.01.

DOI:10.21037/tp.2019.09.01
PMID:31993358
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC6970124/
Abstract

The incidence of paediatric Crohn's disease (CD) and ulcerative colitis (UC) is increasing. Surgical intervention is required during childhood in approximately 25% of children diagnosed with CD, and for 10% of those diagnosed with UC. Although there is evidence that the rate of surgical intervention undertaken in children is decreasing since the introduction of biologic therapy, this may only represent a delay rather than true reversal of the risk of surgery. Surgery for CD is not curative and limited resection is the key principle thus preserving bowel length. For UC, subtotal colectomy is relatively curative; ileo-anal pouch anastomosis can be performed to restore bowel continuity.

摘要

儿童克罗恩病(CD)和溃疡性结肠炎(UC)的发病率正在上升。在确诊为CD的儿童中,约25%在儿童期需要手术干预,而确诊为UC的儿童中这一比例为10%。尽管有证据表明,自生物治疗引入以来,儿童接受手术干预的比例在下降,但这可能只是延迟了手术风险,而非真正降低了风险。CD手术无法治愈,有限切除是关键原则,从而保留肠管长度。对于UC,次全结肠切除术相对可治愈;可进行回肠肛管吻合术以恢复肠道连续性。

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本文引用的文献

1
Increased prevalence of anti-TNF therapy in paediatric inflammatory bowel disease is associated with a decline in surgical resections during childhood.在儿科炎症性肠病中,抗 TNF 治疗的患病率增加与儿童时期手术切除率的下降有关。
Aliment Pharmacol Ther. 2019 Feb;49(4):398-407. doi: 10.1111/apt.15094. Epub 2019 Jan 9.
2
Long-term Single-centre Outcomes After Proctocolectomy With Ileoanal Anastomosis for Paediatric Ulcerative Colitis.儿童溃疡性结肠炎行直肠结肠切除回肠肛管吻合术的长期单中心结局
J Crohns Colitis. 2019 Mar 26;13(3):302-308. doi: 10.1093/ecco-jcc/jjy175.
3
The Effect of Biologics on Postoperative Complications in Children With Inflammatory Bowel Disease and Bowel Resection.生物制剂对炎症性肠病和肠切除术后儿童术后并发症的影响。
J Pediatr Gastroenterol Nutr. 2019 Mar;68(3):334-338. doi: 10.1097/MPG.0000000000002159.
4
Management of Paediatric Ulcerative Colitis, Part 2: Acute Severe Colitis-An Evidence-based Consensus Guideline From the European Crohn's and Colitis Organization and the European Society of Paediatric Gastroenterology, Hepatology and Nutrition.儿科溃疡性结肠炎的管理,第 2 部分:急性重度结肠炎——来自欧洲克罗恩病和结肠炎组织以及欧洲儿童胃肠病学、肝病学和营养学学会的循证共识指南。
J Pediatr Gastroenterol Nutr. 2018 Aug;67(2):292-310. doi: 10.1097/MPG.0000000000002036.
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Management of Paediatric Ulcerative Colitis, Part 1: Ambulatory Care-An Evidence-based Guideline From European Crohn's and Colitis Organization and European Society of Paediatric Gastroenterology, Hepatology and Nutrition.儿童溃疡性结肠炎的管理,第 1 部分:门诊护理-来自欧洲克罗恩病和结肠炎组织和欧洲儿童胃肠病学、肝病学和营养学学会的循证指南。
J Pediatr Gastroenterol Nutr. 2018 Aug;67(2):257-291. doi: 10.1097/MPG.0000000000002035.
6
Laparoscopic ileocaecal resection versus infliximab for terminal ileitis in Crohn's disease: a randomised controlled, open-label, multicentre trial.腹腔镜回肠末端切除术与英夫利昔单抗治疗克罗恩病末端回肠炎的随机对照、开放标签、多中心试验。
Lancet Gastroenterol Hepatol. 2017 Nov;2(11):785-792. doi: 10.1016/S2468-1253(17)30248-0. Epub 2017 Aug 31.
7
Surgical Management of Crohn Disease in Children: Guidelines From the Paediatric IBD Porto Group of ESPGHAN.儿童克罗恩病的手术治疗:欧洲儿科胃肠病、肝病和营养学会(ESPGHAN)儿科炎症性肠病波尔图小组指南
J Pediatr Gastroenterol Nutr. 2017 May;64(5):818-835. doi: 10.1097/MPG.0000000000001562.
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J Pediatr Gastroenterol Nutr. 2017 May;64(5):e117-e124. doi: 10.1097/MPG.0000000000001447.
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Am Surg. 2016 Oct;82(10):977-981.
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Predictors of Pouchitis After Ileal Pouch-Anal Anastomosis in Children.儿童回肠储袋肛管吻合术后袋炎的预测因素
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