Department of Pediatric Surgery, Hôpital Universitaire Robert Debré, Assistance Publique Hôpitaux de Paris, Université de Paris, Paris, France.
Department of Pediatric Pathology, Hôpital Universitaire Robert Debré, Assistance Publique Hôpitaux de Paris, Université de Paris, Paris, France.
Eur J Pediatr Surg. 2024 Jun;34(3):253-260. doi: 10.1055/a-2048-7407. Epub 2023 Mar 7.
The aim of this retrospective study was to describe the risk of postoperative recurrence (POR) after ileocecal resection, the occurrence of surgical complications, and identify predictors of these adverse postoperative outcomes in pediatric Crohn's disease (CD).
All the children less than 18 years of age with a diagnosis of CD, who underwent primary ileocecal resection for CD between January 2006 and December 2016 in our tertiary center, were considered for inclusion. Factors related to POR were investigated.
A total of 377 children were followed for CD between 2006 and 2016. During this period, 45 (12%) children needed an ileocecal resection. POR was diagnosed in 16% ( = 7) at 1 year and 35% ( = 15) at the end of the follow-up, with a median follow-up of 2.3 years (Q1-Q3 1.8-3.3). Median duration of the postoperative clinical remission was 1.5 years (range 0.5-2). Multivariate Cox regression analysis identified only young age at diagnosis as a risk factor for POR.In total, 7 of the 43 patients (16%) developed severe postoperative complications, defined as requiring surgical, endoscopic, or radiological intervention. The only risk factor was intraoperative abscess.
Only young age at diagnosis was associated with POR. This information could be useful to develop targeted therapeutic strategies for young CD children. At the end of follow-up with a median follow-up of 2.3 years (Q1-Q3 1.8-3.3), there was no surgical POR: endoscopic dilatation for POR should be considered in order to delay or prevent surgery.
本回顾性研究旨在描述儿童克罗恩病（CD）行回肠末端切除术（ileocecal resection）后的术后复发（postoperative recurrence，POR）风险、手术并发症的发生情况，并确定这些不良术后结局的预测因素。
纳入标准为 2006 年 1 月至 2016 年 12 月期间在我院接受初次回肠末端切除术治疗 CD 的年龄＜18 岁的所有儿童。分析与 POR 相关的因素。
共 377 例儿童在 2006 年至 2016 年期间接受 CD 随访。在此期间，45 例（12%）儿童需要行回肠末端切除术。术后 1 年 POR 诊断率为 16%（7 例），随访结束时 POR 诊断率为 35%（15 例），中位随访时间为 2.3 年（Q1-Q3：1.8-3.3）。术后临床缓解的中位时间为 1.5 年（范围：0.5-2）。多变量 Cox 回归分析仅发现诊断时年龄较小是 POR 的危险因素。43 例患者中共有 7 例（16%）发生严重术后并发症，定义为需要手术、内镜或影像学干预。唯一的危险因素是术中脓肿。
仅诊断时年龄较小与 POR 相关。这些信息可能有助于为年轻 CD 患儿制定针对性的治疗策略。在中位随访时间为 2.3 年（Q1-Q3：1.8-3.3）的随访结束时，没有手术 POR：应考虑 POR 的内镜扩张，以延迟或预防手术。
