Yu C S, Pemberton J H, Larson D
Division of Colon and Rectal Surgery and Biostatistics, Mayo Clinic and Mayo Foundation, Rochester, Minnesota 55905, USA.
Dis Colon Rectum. 2000 Nov;43(11):1487-96. doi: 10.1007/BF02236726.
Patients with chronic ulcerative colitis who undergo proctocolectomy and are found intraoperatively to harbor histologic signs suggesting Crohn's disease have indeterminate colitis; nonetheless, ileal pouch-anal anastomosis is usually performed. The aim of this study was to determine the long-term outcome of ileal pouch-anal anastomosis in patients with indeterminate colitis compared with a cohort of patients with chronic ulcerative colitis.
Review of an ileal pouch-anal anastomosis registry identified 1,437 patients with chronic ulcerative colitis and 82 patients with indeterminate colitis who underwent an ileal pouch-anal anastomosis between 1981 and 1995. The median follow-up was 83 (range, 1-192) months. Demographic data and functional outcomes were compared by chi-squared and Wilcoxon's rank-sum tests. Probabilities of complications and pouch failure were analyzed using Kaplan-Meier and log-rank techniques. Finally, Bonferroni adjustments were used for multiple comparisons.
Patients with indeterminate colitis and chronic ulcerative colitis were comparable in terms of gender and length of follow-up. The mean age of the chronic ulcerative colitis group was higher (34 vs. 31; P < 0.01). At ten years patients with indeterminate colitis had significantly more episodes of pelvic sepsis (17 percent indeterminate colitis vs. 7 percent chronic ulcerative colitis; P < 0.001), pouch fistula (31 vs. 9 percent; P < 0.001), and pouch failure (27 vs. 11 percent; P < 0.001). Importantly, during follow-up fully 15 percent of patients with indeterminate colitis, but only 2 percent of patients with chronic ulcerative colitis, had their original diagnosis changed to Crohn's disease (P < 0.001). When the outcomes of these patients newly diagnosed with Crohn's disease were considered separately, the rate of complications for the remaining patients with indeterminate colitis was identical to that of patients with chronic ulcerative colitis. Functional outcomes were comparable among all three groups.
After ileal pouch-anal anastomosis patients with indeterminate colitis who did not develop Crohn's disease subsequently experienced long-term outcomes nearly identical to patients with chronic ulcerative colitis. Crohn's disease, whether it develops after surgery for chronic ulcerative colitis or indeterminate colitis, is associated with poor long-term outcomes.
接受全结直肠切除的慢性溃疡性结肠炎患者，若术中发现有提示克罗恩病的组织学征象，则为不确定性结肠炎；尽管如此，通常仍会进行回肠贮袋肛管吻合术。本研究的目的是确定不确定性结肠炎患者与慢性溃疡性结肠炎患者队列相比，回肠贮袋肛管吻合术的长期疗效。
回顾一个回肠贮袋肛管吻合术登记处，确定了1981年至1995年间接受回肠贮袋肛管吻合术的1437例慢性溃疡性结肠炎患者和82例不确定性结肠炎患者。中位随访时间为83（范围1 - 192）个月。通过卡方检验和威尔科克森秩和检验比较人口统计学数据和功能结局。使用Kaplan - Meier法和对数秩检验分析并发症和贮袋失败的概率。最后，采用邦费罗尼校正进行多重比较。
不确定性结肠炎患者和慢性溃疡性结肠炎患者在性别和随访时间方面具有可比性。慢性溃疡性结肠炎组的平均年龄更高（34岁对31岁；P < 0.01）。在十年时，不确定性结肠炎患者的盆腔脓毒症发作次数显著更多（不确定性结肠炎为17%，慢性溃疡性结肠炎为7%；P < 0.001）、贮袋瘘（31%对9%；P < 0.001）和贮袋失败（27%对11%；P < 0.001）。重要的是，在随访期间，完全有15%的不确定性结肠炎患者，但只有2%的慢性溃疡性结肠炎患者，其最初诊断改为克罗恩病（P < 0.001）。当单独考虑这些新诊断为克罗恩病的患者的结局时，其余不确定性结肠炎患者的并发症发生率与慢性溃疡性结肠炎患者相同。所有三组的功能结局具有可比性。
回肠贮袋肛管吻合术后，未继发克罗恩病的不确定性结肠炎患者随后的长期结局与慢性溃疡性结肠炎患者几乎相同。克罗恩病，无论它是在慢性溃疡性结肠炎还是不确定性结肠炎手术后发生，都与不良的长期结局相关。
