目的:(1)确定克罗恩病(CD)和新的放射性回肠狭窄患儿的手术治疗频率,(2)确定预测手术需要的影像学和临床特征。
方法:这项回顾性研究纳入了儿童患者(<21岁)的CD和由MRE诊断的新回肠狭窄,CTE,或CT在2018年7月至2023年6月之间。三名经过董事会认证的放射科医生记录了狭窄的长度,最大壁画厚度,最小管腔直径,最大上游直径,简化磁共振活动指数(sMaRIA)评分。人体测量学,实验室数据,并记录狭窄诊断后进行的手术干预.多变量逻辑回归用于确定与手术需要相关的影像学和临床变量。
结果:44例小儿CD患者(中位年龄16.5岁)在研究期间出现新的回肠狭窄。30例(68.2%)患者需要手术,狭窄诊断和手术之间的中位时间为87.5天。中值狭窄测量为长度:7.0厘米,最大壁画厚度:7.3毫米,最小管腔直径:0.2厘米,和最大上游直径:3.3厘米。sMaRIA评分中位数为3.0,14例(31.8%)狭窄患有相关的内部穿透性疾病。狭窄率(最大上游管腔直径与最小管腔直径之比)(OR=1.15[95%CI1.02-1.30];p=0.02)和sMaRIA(OR=2.12[95%CI0.87-5.17;p=0.10)与手术需要相关。
结论:手术在狭窄的小儿CD中仍然很常见,随着狭窄率和sMaRIA评分的增加与手术治疗的需要相关。
OBJECTIVE: (1) To determine the frequency of surgical management in children with Crohn\'s Disease (CD) and a new radiologic ileal
stricture, and (2) to identify imaging and clinical features that predict the need for surgery.
METHODS: This retrospective
study included pediatric patients (< 21 years old) with CD and a new ileal
stricture diagnosed by MRE, CTE, or CT between July 2018 and June 2023. Three board-certified radiologists recorded stricture length, maximum mural thickness, minimum lumen diameter, maximum upstream diameter, and simplified magnetic resonance index of activity (sMaRIA) score. Anthropometrics, laboratory data, and surgical interventions performed after stricture diagnosis were also recorded. Multivariable logistic regression was used to identify imaging and clinical variables associated with the need for surgery.
RESULTS: 44 pediatric CD patients (median age 16.5 years) presented with a new ileal stricture during the
study period. 30 (68.2%) patients required surgery, with a median time of 87.5 days between
stricture diagnosis and surgery. Median stricture measurements were length: 7.0 cm, maximum mural thickness: 7.3 mm, minimum lumen diameter: 0.2 cm, and maximum upstream diameter: 3.3 cm. Median sMaRIA score was 3.0, and 14 (31.8%) strictures had associated internal penetrating disease. Stricture ratio (ratio of maximum upstream lumen diameter to minimum lumen diameter) (OR = 1.15 [95% CI 1.02-1.30]; p = 0.02) and sMaRIA (OR = 2.12 [95% CI 0.87-5.17; p = 0.10) were associated with need for surgery.
CONCLUSIONS: Surgery remains common in stricturing pediatric CD, with increasing stricture ratio and sMaRIA score associated with need for surgical management.