Department of Pediatric Surgery, Amsterdam UMC Locatie AMC, Amsterdam, the Netherlands.
Department of Surgery, Amsterdam UMC Locatie AMC, Amsterdam, the Netherlands.
Eur J Pediatr Surg. 2024 Jun;34(3):282-289. doi: 10.1055/a-2067-4847. Epub 2023 Apr 1.
A stoma will cause nutrients loss which could result in impaired growth. Impaired growth can negatively impact long-term development. This study aims to evaluate: (1) the effect of stomas on growth comparing small bowel stoma versus colostomy and (2) if early closure (within 6 weeks), proximal small bowel stoma (within 50 cm of Treitz), major small bowel resection (≥ 30 cm), or adequate sodium supplementation (urinary level ≤ 30 mmol/L) influences growth.
Young children (≤ 3 years) treated with stomas between 1998 and 2018 were retrospectively identified. Growth was measured with weight-for-age Z-scores. Malnourishment was defined using the World Health Organization's definition. Comparison between changes in Z-scores at creation, closure, and a year following closure was done by Friedman's test with post hoc Wilcoxon's signed rank test or Wilcoxon's rank-sum test when necessary.
In the presence of a stoma in 172 children, 61% showed growth decline. Severe malnourishment was seen at the time of stoma closure in 51% of the patients treated by small bowel stoma and 16% of those treated by colostomy. Within a year following stoma closure, 67% showed a positive growth trend. Having a proximal small bowel stoma and undergoing major small bowel resection led to significantly lower Z-scores at closure. Adequate sodium supplementation and early closure did not lead to significant changes in Z-scores.
Stomas have a negative impact on growth in the majority of children. This impact might be decreased by preventing small bowel stomas when possible, specifically proximal stomas, and limiting small bowel resection. Since stoma closure is essential in reversing the negative effect on growth, we opt that early closure might result in an early shift to catch-up growth.
造口会导致营养流失，从而影响生长。生长受损会对长期发育产生负面影响。本研究旨在评估：（1）比较小肠造口与结肠造口对生长的影响；（2）早期关闭（6 周内）、近端小肠造口（Treitz 以下 50cm 内）、小肠主要切除（≥30cm）或充分钠补充（尿钠水平≤30mmol/L）是否影响生长。
回顾性分析 1998 年至 2018 年间接受造口治疗的≤3 岁儿童。采用体重-年龄 Z 评分评估生长情况。根据世界卫生组织的定义，营养不良定义为。通过 Friedman 检验比较造口建立时、关闭时和关闭后 1 年时 Z 评分的变化，必要时采用 Wilcoxon 符号秩检验或 Wilcoxon 秩和检验。
在 172 例存在造口的患儿中，61%出现生长下降。51%的小肠造口患儿和 16%的结肠造口患儿在造口关闭时出现严重营养不良。造口关闭后 1 年内，67%的患儿出现正增长趋势。近端小肠造口和小肠主要切除导致关闭时 Z 评分显著降低。充分钠补充和早期关闭并未导致 Z 评分显著变化。
造口对大多数儿童的生长有负面影响。通过尽可能避免小肠造口，特别是近端造口，并限制小肠切除，可以减少这种影响。由于造口关闭对于逆转生长的负面影响至关重要，我们认为早期关闭可能导致早期追赶性生长。
