Tonelli F, Valanzano R, Messerini L, Ficari F
Department of Clinical Physiopathology, Surgical Unit, University of Florence, Italy.
J Surg Oncol. 2000 May;74(1):15-20. doi: 10.1002/1096-9098(200005)74:1<15::aid-jso4>3.0.co;2-z.
Ileorectal anastomosis (IRA) is still used in the treatment of familial adenomatous polyposis (FAP). Sulindac appears to induce regression of colorectal adenomas; however, its effects in long-term therapy and in preventing carcinoma remain unclear.
Fifteen FAP patients treated by IRA received sulindac (200 mg/day) for a mean period of 48.6 +/- 28.7 (range 12-124) months. Number, size, and type of rectal polyps were assessed by endoscopic and histological evaluation every 6 months.
Significant regression of polyps was observed in all patients after 6 months (P < 0.02). However, after a mean of 48.6 +/- 28.7 months, both number and size of polyps increased again, showing no statistical difference with baseline values. Minute polyps appeared reddish, while the largest lesions were flat or slightly elevated. Endoscopic polypectomy was necessary in 9 patients and transanal surgical excision in 3. Two patients were submitted to restorative proctectomy because of a large polyp with severe dysplasia and a rectal cancer, respectively.
Sulindac appears to influence the morphological appearance of polyps in FAP patients, inducing apparent regression. However, at a dose of 200 mg, it does not influence the progression of polyps toward a malignant pattern.
回肠直肠吻合术（IRA）仍用于家族性腺瘤性息肉病（FAP）的治疗。舒林酸似乎可使结直肠腺瘤消退；然而，其在长期治疗及预防癌症方面的效果仍不明确。
15例接受IRA治疗的FAP患者接受舒林酸（200毫克/天）治疗，平均疗程为48.6±28.7（范围12 - 124）个月。每6个月通过内镜和组织学评估直肠息肉的数量、大小和类型。
6个月后所有患者息肉均出现显著消退（P < 0.02）。然而，平均48.6±28.7个月后，息肉的数量和大小再次增加，与基线值无统计学差异。微小息肉呈红色，而最大的病变为扁平或略隆起。9例患者需要内镜下息肉切除术，3例需要经肛门手术切除。分别有2例患者因大息肉伴重度发育异常和直肠癌而接受了保留性直肠切除术。
舒林酸似乎会影响FAP患者息肉的形态外观，导致明显消退。然而，200毫克的剂量并不影响息肉向恶性形态的进展。
