Brunel M, Penna C, Tiret E, Balladur P, Parc R
Department of Alimentary Tract Surgery, Hôpital Saint-Antoine, 75012 Paris, France.
Gut. 1999 Oct;45(4):542-5. doi: 10.1136/gut.45.4.542.
Chronic distal colitis may cause troublesome symptoms and alter quality of life. When medical treatment fails to control symptoms, patients and doctors are often reluctant to consider surgical resection because of the relatively small portion of the large bowel affected by the disease.
To assess the outcome of restorative proctocolectomy (RP) in patients with distal colitis who required surgery for chronic debilitating symptoms and failed medical management.
PATIENTS/METHODS: From 1986 to 1996, of 263 patients receiving RP for ulcerative colitis, 27 (16 men) were operated on for distal ulcerative colitis limited to the rectum and sigmoid colon. Bowel function and quality of life were compared before and one year after RP.
The mean (SD) duration of ulcerative colitis was 11 (6) years. RP was performed at a mean age of 46 (10) years. All the pouches were J-shaped, and a diverting loop ileostomy was always performed. Mean (SD) hospital stay was 25 (10) days. Seven complications occurred in six patients. Previously unknown severe dysplasia was discovered on the colectomy specimen in two patients. After RP there was a significant decrease in mean (SD) daytime stool frequency (8.2 (4) v 4.7 (2), p<0.05), night-time stool frequency (2 (2) v 1 (1), p = 0.05), and the number of patients with urgency to defecate (26/27 v 1/27, p<0.001). Sex life was improved in eight patients, social life in 26, and professional life in eight. Twenty six patients were satisfied with the results, and 25 wished that they had received surgery earlier in the course of their disease.
RP can improve bowel function and quality of life in patients with disabling chronic symptoms of distal ulcerative colitis.
慢性远端结肠炎可能导致令人烦恼的症状并改变生活质量。当药物治疗无法控制症状时，由于受该疾病影响的大肠部分相对较小，患者和医生通常不愿考虑手术切除。
评估因慢性衰弱症状而需要手术且药物治疗无效的远端结肠炎患者行结直肠全切除回肠储袋肛管吻合术（RP）的效果。
患者/方法：1986年至1996年，在263例行RP治疗溃疡性结肠炎的患者中，27例（16例男性）因局限于直肠和乙状结肠的远端溃疡性结肠炎接受手术。比较RP术前和术后一年的肠道功能及生活质量。
溃疡性结肠炎的平均（标准差）病程为11（6）年。RP手术时的平均年龄为46（10）岁。所有储袋均为J形，且均行转流性回肠造口术。平均（标准差）住院时间为25（10）天。6例患者出现7例并发症。2例患者在结肠切除标本上发现了先前未知的严重发育异常。RP术后，平均（标准差）日间排便次数（8.2（4）对4.7（2），p<0.05）、夜间排便次数（2（2）对1（1），p = 0.05）以及有排便紧迫感的患者数量（26/27对1/27，p<0.001）均显著减少。8例患者性生活改善，26例社交生活改善，8例职业生活改善。26例患者对结果满意，25例希望在病程中更早接受手术。
RP可改善伴有致残性慢性症状的远端溃疡性结肠炎患者的肠道功能和生活质量。
