Soravia C, Klein L, Berk T, O'Connor B I, Cohen Z, McLeod R S
Department of Surgery, Mount Sinai Hospital, University of Toronto, Ontario, Canada.
Dis Colon Rectum. 1999 Aug;42(8):1028-33; discussion 1033-4. doi: 10.1007/BF02236696.
The aim of this study was to evaluate the surgical complications and long-term outcome and assess the functional results and quality of life after ileorectal anastomosis and ileal pouch-anal anastomosis in patients with familial adenomatous polyposis.
From 1980 to 1997, 131 patients with familial adenomatous polyposis were operated on or were followed up or both at the Familial Gastrointestinal Cancer Registry at Mount Sinai Hospital. Demographic and operative data were prospectively collected in the ileal pouch-anal anastomosis group, and retrospectively in the ileorectal anastomosis group. A questionnaire or telephone interview or both were undertaken to evaluate functional outcome and quality of life.
The ileorectal anastomosis group consisted of 60 patients (mean age, 31 years; mean follow-up, 7.7 years). In the ileal pouch-anal anastomosis group there were 50 patients (mean age, 35 years; mean follow-up, 6 years). There were no statistically significant differences with respect to anastomotic leak rate in ileal pouch-anal anastomosis vs. ileorectal anastomosis (12 vs. 3 percent; P = 0.21), risk of small-bowel obstruction (24 vs. 15 percent; P = 0.58), and risk of intra-abdominal sepsis (3 vs. 2 percent; P = 0.86). Reoperation rate was similar in the two groups (14 vs. 16 percent; P = 0.94). Twenty-one patients (37 percent) with ileorectal anastomosis were converted to ileal pouch-anal anastomosis (12 patients) or proctocolectomy (9 patients), because of rectal cancer (5 patients), dysplasia (1 patient), or uncontrollable rectal polyps (15 patients). Two pelvic pouches were excised, and another one was defunctioned. Information regarding functional results and quality of life was obtained in 40 patients (66.6 percent) in the ileorectal anastomosis group and in 43 patients (86 percent) in the ileal pouch-anal anastomosis group. Patients with ileorectal anastomosis had a significantly better functional outcome with regard to nighttime continence and perineal skin irritation. But otherwise, functional results and quality of life were similar.
Although ileorectal anastomosis has a better functional outcome, ileal pouch-anal anastomosis may be preferable because of the lower long-term failure rate. Ileorectal anastomosis is still an option in patients with familial adenomatous polyposis with rectal polyp sparing and good compliance for follow-up.
本研究旨在评估家族性腺瘤性息肉病患者行回肠直肠吻合术和回肠储袋肛管吻合术后的手术并发症及长期预后，并评估其功能结果和生活质量。
1980年至1997年，131例家族性腺瘤性息肉病患者在西奈山医院家族性胃肠癌登记处接受手术、随访或两者皆有。前瞻性收集回肠储袋肛管吻合术组的人口统计学和手术数据，回肠直肠吻合术组则进行回顾性收集。通过问卷调查或电话访谈或两者结合来评估功能结果和生活质量。
回肠直肠吻合术组有60例患者（平均年龄31岁；平均随访7.7年）。回肠储袋肛管吻合术组有50例患者（平均年龄35岁；平均随访6年）。回肠储袋肛管吻合术与回肠直肠吻合术在吻合口漏率（12%对3%；P = 0.21）、小肠梗阻风险（24%对15%；P = 0.58）和腹腔内感染风险（3%对2%；P = 0.86）方面无统计学显著差异。两组的再次手术率相似（14%对16%；P = 0.94）。60例回肠直肠吻合术患者中有21例（37%）因直肠癌（5例）、发育异常（1例）或无法控制的直肠息肉（15例）改行回肠储袋肛管吻合术（12例）或直肠结肠切除术（9例）。切除了2个盆腔储袋，另1个使其失去功能。回肠直肠吻合术组40例患者（66.6%）和回肠储袋肛管吻合术组43例患者（86%）获得了关于功能结果和生活质量的信息。回肠直肠吻合术患者在夜间控便和会阴皮肤刺激方面的功能结果明显更好。但除此之外，功能结果和生活质量相似。
虽然回肠直肠吻合术有更好的功能结果，但由于长期失败率较低，回肠储袋肛管吻合术可能更可取。对于保留直肠息肉且随访依从性良好的家族性腺瘤性息肉病患者，回肠直肠吻合术仍是一种选择。
