Karlbom U, Raab Y, Ejerblad S, Graf W, Thörn M, Pâhlman L
Department of Surgery, University Hospital, S-751 85 Uppsala, Sweden.
Br J Surg. 2000 Oct;87(10):1401-8. doi: 10.1046/j.1365-2168.2000.01533.x.
Restorative proctocolectomy is considered to be the procedure of choice in the operative treatment of ulcerative colitis. The aim of this study was to evaluate the functional outcome following operation and to identify possible predictive factors.
Some 168 patients (median age 32 years, 102 men) with ulcerative colitis underwent restorative proctocolectomy. The functional outcome was evaluated by a symptom index created from a questionnaire at a median of 29 (13-123) months of follow-up. The records of these patients were reviewed, and preoperative, peroperative and postoperative variables were registered and related to outcome.
The response rate to the questionnaire was 155 (92 per cent) of 168. The symptom index was related to patients' overall assessment of outcome. In spite of a perceived good result many patients experienced a number of symptoms. Age over 50 years (P < 0.01), presence of extraintestinal manifestations (P < 0.05) and late complications, such as anastomotic stricture (P < 0.05), pouchitis (P < 0.01) and anal pain (P < 0.05), were related to a less favourable outcome.
While preoperative data may help in selecting patients suitable for restorative proctocolectomy, prevention of late complications seems most important in improving the functional outcome.
全直肠系膜切除术被认为是溃疡性结肠炎手术治疗的首选术式。本研究旨在评估手术后的功能结局并确定可能的预测因素。
约168例溃疡性结肠炎患者（中位年龄32岁，男性102例）接受了全直肠系膜切除术。通过一份问卷所创建的症状指数，在中位随访29（13 - 123）个月时对功能结局进行评估。回顾这些患者的记录，登记术前、术中及术后变量并分析其与结局的关系。
168例患者中155例（92%）回复了问卷。症状指数与患者对结局的总体评估相关。尽管很多患者感觉结果良好，但仍有不少人存在一些症状。年龄超过50岁（P < 0.01）、存在肠外表现（P < 0.05）以及出现诸如吻合口狭窄（P < 0.05）、贮袋炎（P < 0.01）和肛门疼痛（P < 0.05）等晚期并发症，均与较差的结局相关。
虽然术前数据可能有助于选择适合全直肠系膜切除术的患者，但预防晚期并发症似乎对改善功能结局最为重要。
