Kim N K, Park J S, Park J K, Sohn S K, Min J S
Department of Surgery, Yonsei University College of Medicine, Seoul, Korea.
Yonsei Med J. 2000 Oct;41(5):634-41. doi: 10.3349/ymj.2000.41.5.634.
Restorative proctocolectomy (total proctocolectomy and ileal J pouch anal anastomosis) has been accepted as the operation of choice in the setting of chronic ulcerative colitis and familial adenomatous polyposis. The purpose of this study was to assess operative safety and functional outcome after restorative proctocolectomy. A total of sixteen patients underwent surgery between January 1996 and December 1999. Hand sewn anastomosis with diverting ileostomy was performed in 9 patients and double stapled anastomosis in 7 patients. The underlying disease was ulcerative colitis in 9 cases and familial adenomatous polyposis in 7. Postoperative complications developed in 8 cases (50%), and intestinal obstruction was found in 4 cases (2 cases were operated upon). Anastomosis related complications were stenosis (n=2), leak (n=1) and perianal abscess (n=1). All patients were followed up at the outpatient clinic using questionnaires, with a mean follow up period of 19.9 months. The frequency of bowel movement was 8.2 per day in hand sewn anastomosis (HS), and 12 per day in double stapled anastomosis (DS) 3 months after surgery (period 1). This frequency decreased to 5.5 per day in HS, and 4.6 per day in DS after one year (period 2). Day and night continence was shown in 12/15, and 5/15, respectively in period 1, but improved to 10/11, and 10/11, respectively in period 2. Night time incontinence was noted in 10 of 15 patients in period 1 (seepage 3/15, soiling 7/15). The need to take anti-diarrheal medication, and to use a pad was noted in 2/15, and 10/15, respectively in period 1, but no patient took antidiarrheal medication or wore a protective pad in period 2. Postoperative urinary function was satisfactory in 13/14 patients. Postoperative sexual function was analyzed in a total of 8 patients, who showed good erection (5/5), ejaculation (5/5) and satisfactory sexual life (5/5). In females, 3 patients showed a satisfactory sexual life. In conclusion, restorative proctocolectomy for chronic ulcerative colitis and familial adenomatous polyposis can be performed safely with excellent functional outcomes, including bowel movement, urinary and sexual functions one year after surgery.
保留性直肠结肠切除术（全直肠结肠切除术及回肠J袋肛管吻合术）已被公认为是治疗慢性溃疡性结肠炎和家族性腺瘤性息肉病的首选术式。本研究旨在评估保留性直肠结肠切除术后的手术安全性和功能结局。1996年1月至1999年12月期间，共有16例患者接受了手术。9例患者采用手工缝合吻合术并做转流性回肠造口术，7例患者采用双吻合器吻合术。基础疾病为溃疡性结肠炎9例，家族性腺瘤性息肉病7例。术后8例（50%）出现并发症，4例（2例接受了手术治疗）发现肠梗阻。吻合口相关并发症有狭窄（n = 2）、渗漏（n = 1）和肛周脓肿（n = 1）。所有患者均在门诊通过问卷调查进行随访，平均随访时间为19.9个月。术后3个月（第1阶段），手工缝合吻合术（HS）组患者每日排便次数为8.2次，双吻合器吻合术（DS）组为12次。1年后（第2阶段），HS组该频率降至每日5.5次，DS组降至每日4.6次。第1阶段，日间和夜间控便率分别为12/15和5/15，但在第2阶段分别提高至10/11和10/11。第1阶段，15例患者中有10例存在夜间失禁（3/15渗漏，7/15污染）。第1阶段，分别有2/15和10/15的患者需要服用止泻药和使用护垫，但在第2阶段，无患者服用止泻药或使用护垫。14例患者术后排尿功能满意。共对8例患者的术后性功能进行了分析，结果显示勃起功能良好（5/5）、射精功能良好（5/5）且性生活满意度良好（5/5）。女性患者中有3例性生活满意。总之，对于慢性溃疡性结肠炎和家族性腺瘤性息肉病患者，保留性直肠结肠切除术可安全实施，术后1年在排便、排尿及性功能等方面功能结局良好。
