在儿科克罗恩病中使用 Kono-S 吻合术：单机构经验。

Use of the Kono-S anastomosis in pediatric Crohn's disease: a single-institution experience.

机构信息

Department of Colorectal Surgery, Cleveland Clinic Foundation, Cleveland, OH, USA.

Department of General Surgery, Digestive Disease Institute, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH, 44195, USA.

出版信息

Pediatr Surg Int. 2023 Nov 10;39(1):290. doi: 10.1007/s00383-023-05572-1.

DOI:10.1007/s00383-023-05572-1

PMID:37947950

Abstract

OBJECTIVES

About 24% of children with Crohn's Disease (CD) require surgery. In 2003, Kono et al. described a novel anastomosis reported to decrease the rate of anastomotic CD recurrence. Subsequent studies have reproduced these outcomes, but none has demonstrated its effect in pediatric patients. This study evaluates short-term outcomes of pediatric patients following ileocolic resection and Kono-S anastomosis.

METHODS

A retrospective review of patients < 18 years old who underwent ileocolic resection followed by Kono-S anastomosis compared with those who underwent a stapled anastomosis.

RESULTS

Nine Kono-S patients were matched with nine patients preceding them who received traditional side-to-side and end-to-side anastomoses. All patients underwent minimally invasive surgery. Demographics, pre-operative medication usage, and symptom profiles were not significantly different. Traditional anastomosis (TA) patients had longer lengths of stay (4.6 vs 2.9 days; p = 0.03) but had no statistically significant differences in blood loss, procedure length, and pathologic findings. One Kono-S patient had a superficial surgical site infection, and one TA patient had an anastomotic leak requiring reoperation within 30 days. More TA patients experienced post-operative symptoms at both 30-day and 6-month follow-up (66.7% vs 33.3%; p = 0.16 and 77.8% vs 25%; p = 0.03).

CONCLUSION

The Kono-S anastomosis appears to be safe in pediatric CD when compared to traditional stapled anastomoses.

摘要

目的

约 24%的克罗恩病（CD）患儿需要手术。2003 年，Kono 等人描述了一种新的吻合术，据报道可降低吻合口 CD 复发率。随后的研究复制了这些结果，但没有一项研究证明其在儿科患者中的效果。本研究评估了行回肠结肠切除术和 Kono-S 吻合术的小儿患者的短期结局。

方法

回顾性分析了<18 岁接受回肠结肠切除术和 Kono-S 吻合术的患者与接受吻合术的患者的资料。

结果

9 例 Kono-S 患者与之前接受传统侧侧吻合术和端端吻合术的 9 例患者相匹配。所有患者均接受微创外科手术。患者的人口统计学、术前用药和症状特征无显著差异。传统吻合术（TA）患者的住院时间更长（4.6 天 vs 2.9 天；p=0.03），但失血量、手术时间和病理发现无统计学差异。1 例 Kono-S 患者发生浅表手术部位感染，1 例 TA 患者术后 30 天内发生吻合口漏，需要再次手术。更多的 TA 患者在术后 30 天和 6 个月随访时出现术后症状（66.7% vs 33.3%；p=0.16 和 77.8% vs 25%；p=0.03）。