{"title":"局部克罗恩病患儿受益于早期回盲部切除术和围手术期抗肿瘤坏死因子疗法","authors":"Elena Weigl, Tobias Schwerd, Eberhard Lurz, Beate Häberle, Sibylle Koletzko, Jochen Hubertus","doi":"10.1055/s-0043-1764320","DOIUrl":null,"url":null,"abstract":"<p><strong>Introduction: </strong> In pediatric Crohn's disease ileocecal resection is performed reluctantly as postoperative recurrence is frequent. Anti-tumor necrosis factor (TNF) therapy reduces postoperative recurrence rates but increases the risk for infections.</p><p><strong>Materials and methods: </strong> We retrospectively reviewed pediatric Crohn's disease patients who underwent ileocecal resection in our center. We compared disease activity and <i>z</i>-scores for height, weight, and body mass index of patients, who continuously received perioperative anti-TNF therapy (TNF + ), with those who did not (TNF-).</p><p><strong>Results: </strong> Of 29 patients (48% females), 13 and 16 were grouped to TNF+ and TNF-, respectively. Patients' characteristics did not differ between groups, except a longer follow-up time in TNF-. We saw significant postoperative improvement but no normalization in <i>z</i>-scores for weight (1.78 vs. 0.77, <i>p</i> < 0.001), body mass index (1.08 vs. 0.22, <i>p</i> < 0.001), and height (0.88 vs. 0.66, <i>p</i> < 0.001). Disease activity improved significantly more in patients receiving anti-TNF therapy (moderate improvement in 83% vs. 31%, <i>p</i> = 0.02). Endoscopic recurrence was more frequent in patients without anti-TNF therapy (80% vs. 20%; <i>p</i> = 0.023), but endoscopic follow-up was incomplete. There was no increase of infections under perioperative anti-TNF therapy (1 patient each; <i>p</i> = 1.000).</p><p><strong>Conclusion: </strong> In patients with localized Crohn's disease an ileocecal resection leads to short-term postoperative improvement of disease activity, body mass index, weight, and growth. For relevant catch-up growth an earlier intervention is necessary. Continuous perioperative anti-TNF therapy had no increased risk of perioperative infections.</p>","PeriodicalId":56316,"journal":{"name":"European Journal of Pediatric Surgery","volume":null,"pages":null},"PeriodicalIF":1.5000,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Children with Localized Crohn's Disease Benefit from Early Ileocecal Resection and Perioperative Anti-Tumor Necrosis Factor Therapy.\",\"authors\":\"Elena Weigl, Tobias Schwerd, Eberhard Lurz, Beate Häberle, Sibylle Koletzko, Jochen Hubertus\",\"doi\":\"10.1055/s-0043-1764320\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Introduction: </strong> In pediatric Crohn's disease ileocecal resection is performed reluctantly as postoperative recurrence is frequent. Anti-tumor necrosis factor (TNF) therapy reduces postoperative recurrence rates but increases the risk for infections.</p><p><strong>Materials and methods: </strong> We retrospectively reviewed pediatric Crohn's disease patients who underwent ileocecal resection in our center. We compared disease activity and <i>z</i>-scores for height, weight, and body mass index of patients, who continuously received perioperative anti-TNF therapy (TNF + ), with those who did not (TNF-).</p><p><strong>Results: </strong> Of 29 patients (48% females), 13 and 16 were grouped to TNF+ and TNF-, respectively. Patients' characteristics did not differ between groups, except a longer follow-up time in TNF-. We saw significant postoperative improvement but no normalization in <i>z</i>-scores for weight (1.78 vs. 0.77, <i>p</i> < 0.001), body mass index (1.08 vs. 0.22, <i>p</i> < 0.001), and height (0.88 vs. 0.66, <i>p</i> < 0.001). Disease activity improved significantly more in patients receiving anti-TNF therapy (moderate improvement in 83% vs. 31%, <i>p</i> = 0.02). Endoscopic recurrence was more frequent in patients without anti-TNF therapy (80% vs. 20%; <i>p</i> = 0.023), but endoscopic follow-up was incomplete. There was no increase of infections under perioperative anti-TNF therapy (1 patient each; <i>p</i> = 1.000).</p><p><strong>Conclusion: </strong> In patients with localized Crohn's disease an ileocecal resection leads to short-term postoperative improvement of disease activity, body mass index, weight, and growth. For relevant catch-up growth an earlier intervention is necessary. Continuous perioperative anti-TNF therapy had no increased risk of perioperative infections.</p>\",\"PeriodicalId\":56316,\"journal\":{\"name\":\"European Journal of Pediatric Surgery\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":1.5000,\"publicationDate\":\"2024-06-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"European Journal of Pediatric Surgery\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1055/s-0043-1764320\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2023/3/16 0:00:00\",\"PubModel\":\"Epub\",\"JCR\":\"Q2\",\"JCRName\":\"PEDIATRICS\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"European Journal of Pediatric Surgery","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1055/s-0043-1764320","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2023/3/16 0:00:00","PubModel":"Epub","JCR":"Q2","JCRName":"PEDIATRICS","Score":null,"Total":0}
引用次数: 0
摘要
引言在小儿克罗恩病中,回盲部切除术因术后复发频繁而被勉强实施。抗肿瘤坏死因子(TNF)疗法可降低术后复发率,但会增加感染风险:我们对在本中心接受回盲部切除术的小儿克罗恩病患者进行了回顾性研究。我们比较了围手术期持续接受抗肿瘤坏死因子治疗(TNF+)和未接受抗肿瘤坏死因子治疗(TNF-)的患者的疾病活动度以及身高、体重和体重指数的 Z 值:29名患者(48%为女性)中,分别有13人和16人被归入TNF+和TNF-组。除了 TNF- 组患者的随访时间较长之外,各组患者的特征并无差异。我们发现术后患者的体重有明显改善,但体重z值没有恢复正常(1.78 vs. 0.77,p p p p = 0.02)。未接受抗肿瘤坏死因子治疗的患者内镜复发率更高(80% 对 20%;P = 0.023),但内镜随访并不完整。在围手术期接受抗肿瘤坏死因子治疗的患者中,感染率没有增加(各1例;P = 1.000):结论:对于局部克罗恩病患者,回盲部切除术可在术后短期内改善疾病活动、体重指数、体重和生长情况。为了实现相关的追赶性生长,有必要尽早进行干预。围手术期持续接受抗肿瘤坏死因子治疗不会增加围手术期感染的风险。
Children with Localized Crohn's Disease Benefit from Early Ileocecal Resection and Perioperative Anti-Tumor Necrosis Factor Therapy.
Introduction: In pediatric Crohn's disease ileocecal resection is performed reluctantly as postoperative recurrence is frequent. Anti-tumor necrosis factor (TNF) therapy reduces postoperative recurrence rates but increases the risk for infections.
Materials and methods: We retrospectively reviewed pediatric Crohn's disease patients who underwent ileocecal resection in our center. We compared disease activity and z-scores for height, weight, and body mass index of patients, who continuously received perioperative anti-TNF therapy (TNF + ), with those who did not (TNF-).
Results: Of 29 patients (48% females), 13 and 16 were grouped to TNF+ and TNF-, respectively. Patients' characteristics did not differ between groups, except a longer follow-up time in TNF-. We saw significant postoperative improvement but no normalization in z-scores for weight (1.78 vs. 0.77, p < 0.001), body mass index (1.08 vs. 0.22, p < 0.001), and height (0.88 vs. 0.66, p < 0.001). Disease activity improved significantly more in patients receiving anti-TNF therapy (moderate improvement in 83% vs. 31%, p = 0.02). Endoscopic recurrence was more frequent in patients without anti-TNF therapy (80% vs. 20%; p = 0.023), but endoscopic follow-up was incomplete. There was no increase of infections under perioperative anti-TNF therapy (1 patient each; p = 1.000).
Conclusion: In patients with localized Crohn's disease an ileocecal resection leads to short-term postoperative improvement of disease activity, body mass index, weight, and growth. For relevant catch-up growth an earlier intervention is necessary. Continuous perioperative anti-TNF therapy had no increased risk of perioperative infections.
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