儿童结肠镜操作及疾病谱分析

Pediatric colonoscopy procedures and disease spectrum analysis

摘要:

目的 探讨儿童结肠镜操作及其相关疾病谱变化。方法 回顾性收集2012年1月至2022年12月南京医科大学第二附属医院及南京医科大学附属伊犁州友谊医院行儿童结肠镜操作的1 087例儿童的临床资料。根据患者年龄将其分为0~3岁组（165例）、4~6岁组（307例）、7~10岁组（275例）及11~14岁组（340例），另根据检查时间节点分为2012—2017年（302例）和2018—2022年（785例）两个时间段。分析结肠镜操作的主要原因、异常发现的类型及比例、不同时期及年龄组的病例分布和症状特点，以及结肠镜操作前后的疾病诊断和治疗情况。结果 1 087例儿童共完成了1 238次结肠镜操作。便血是最常见的原因（337/1 087，31.00%）。发现异常者以肠息肉（190/1 087，17.48%）和炎症性肠病（181/1 087，16.65%）居多，有95例（95/1 087，8.74%）因确诊儿童孤独症而需要进行结肠镜置管粪菌移植治疗。不同年龄组的病例分布和症状有差异，0~3岁组最常见的是息肉（75/165，45.45%），11~14岁组最常见的是炎症性肠病（97/340，28.53%）。2018—2022年与2012—2017年相比，儿童肠息肉结肠镜操作比例下降［从49.67%（150/302）降至5.10%（40/785），P<0.001］，炎症性肠病比例增加［从12.25%（37/302）增加到18.34%（144/785），P=0.016］，孤独症要求结肠镜置管后行菌群移植比例增加［从2.32%（7/302）增加到11.21%（88/785），P<0.001］。结论 儿童结肠镜在儿科疾病的诊断和治疗中发挥着重要作用。随着临床应用的需求增加，多元化操作如菌群移植前置管等，成为未来儿童结肠镜发展的重要方向之一。

Abstract:

Objective To investigate pediatric colonoscopy procedures and the associated changes in the disease spectrum. Methods The clinical data of 1 087 children who underwent pediatric colonoscopy at the Second Affiliated Hospital of Nanjing Medical University and Yili Prefecture Friendship Hospital Affiliated to Nanjing Medical University from January 2012 to December 2022 were retrospectively collected. Patients were divided into 0‑3 (n=165), 4‑6 (n=307), 7‑10 (n=275) and 11‑14 (n=340) years groups according to their age, and also divided into two time periods according to the examination time point, 2012‑2017 (n=302) and 2018‑2022 (n=785) groups. Indicators that were observed and analyzed included the primary reasons for colonoscopy, types and proportions of abnormalities, distribution of cases and symptoms by period and age group, and disease diagnosis and treatment before and after colonoscopy. Results A total of 1 238 colonoscopies were completed in 1 087 children. Blood in the stool was the most common cause (337/1 087, 31.00%). The most abnormalities were found in intestinal polyps (190/1 087, 17.48%) and inflammatory bowel disease (IBD) (181/1 087, 16.65%), as well as in 95 cases (95/1 087, 8.74%) who were confirmed autism and requested colonoscopy placement for fecal microbiota transplantation (FMT). There were differences in case distribution and symptoms among different age groups: polyps were most common in the 0‑3 years group (75/165, 45.45%), and IBD was most common in the 11‑14 years group (97/340, 28.53%). Compared with 2012‑2017, during 2018‑2022, the proportion of colonoscopies for polyps in children decreased [from 49.67% (150/302) to 5.10% (40/785), P<0.001], while the proportion for IBD increased [from 12.25% (37/302) to 18.34% (144/785), P=0.016], and autism requiring colonoscopic duct placement for FMT increased [from 2.32% (7/302) to 11.21% (88/785), P<0.001]. Conclusion Pediatric colonoscopy plays an important role in the diagnosis and treatment of pediatric diseases. With the increasing clinical application demands, diversified procedures such as pre‑FMT colonoscopic duct placement are becoming important directions for the future development of pediatric colonoscopy.