Section of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Comer Children's Hospital, Chicago, IL, USA.
University of Chicago Medicine Inflammatory Bowel Disease Center, Chicago, IL, USA.
Inflamm Bowel Dis. 2022 Sep 1;28(9):1386-1394. doi: 10.1093/ibd/izab319.
Despite significant differences in surgical outcomes between pediatric and adult patients with ulcerative colitis (UC) undergoing colectomy, counseling on pediatric outcomes has largely been guided by data from adults. We compared differences in pouch survival between pediatric and adult patients who underwent total proctocolectomy with ileal pouch-anal anastomosis (IPAA).
This was a retrospective single-center study of patients with UC treated with IPAA who subsequently underwent pouchoscopy between 1980 and 2019. Data were collected via electronic medical records. We stratified the study population based on age at IPAA. Differences between groups were assessed using t tests and chi-square tests. Kaplan-Meier curves were used to compare survival probabilities. Differences between groups were assessed using a log-rank test.
We identified 53 patients with UC who underwent IPAA before 19 years of age and 329 patients with UC who underwent IPAA at or after 19 years of age. Subjects who underwent IPAA as children were more likely to require anti-tumor nerosis factor (TNF) postcolectomy compared with adults (41.5% vs 25.8%; P < .05). Kaplan-Meier estimates revealed that pediatric patients who underwent IPAA in the last 10 years had a 5-year pouch survival probability that was 28% lower than that of those who underwent surgery in the 1990s or 2000s (72% vs 100%; P < .001). Further, children who underwent IPAA and received anti-TNF therapies precolectomy had the most rapid progression to pouch failure when compared with anti-TNF-naive children and with adults who were either exposed or naive precolectomy (P < .05).
There are lower rates of pouch survival for children with UC who underwent IPAA following the uptake of anti-TNF therapy compared with both historical pediatric control subjects and contemporary adults.
尽管患有溃疡性结肠炎（UC）的儿科和成年患者在接受结肠切除术方面的手术结果存在显著差异，但针对儿科结果的咨询在很大程度上是基于来自成年人的数据。我们比较了接受全直肠结肠切除加回肠储袋肛管吻合术（IPAA）的儿科和成年患者之间储袋存活率的差异。
这是一项回顾性单中心研究，纳入了 1980 年至 2019 年间接受 IPAA 治疗后行储袋内镜检查的 UC 患者。通过电子病历收集数据。我们根据 IPAA 时的年龄对研究人群进行分层。使用 t 检验和卡方检验评估组间差异。使用 Kaplan-Meier 曲线比较生存概率。使用对数秩检验评估组间差异。
我们确定了 53 例在 19 岁之前接受 IPAA 的 UC 患者和 329 例在 19 岁或之后接受 IPAA 的 UC 患者。与成年人相比，接受 IPAA 的儿童更有可能在结肠切除术后需要使用抗肿瘤坏死因子（TNF）（41.5%比 25.8%；P <.05）。Kaplan-Meier 估计表明，过去 10 年内接受 IPAA 的儿科患者的 5 年储袋生存率比 20 世纪 90 年代或 21 世纪初接受手术的患者低 28%（72%比 100%；P <.001）。此外，与接受抗 TNF 治疗的儿童相比，接受 IPAA 且术前接受抗 TNF 治疗的儿童与接受术前抗 TNF 治疗的儿童和接受术前抗 TNF 治疗的成年人相比，储袋失败的进展最快（P <.05）。
与历史上的儿科对照患者和当代成年人相比，接受 IPAA 的 UC 儿童在接受抗 TNF 治疗后，储袋生存率较低。
