Mylonakis E, Allan R N, Keighley M R
University Department of Surgery, Queen Elizabeth Hospital, Edgbaston, Birmingham B15 2TH, United Kingdom.
Dis Colon Rectum. 2001 Aug;44(8):1137-42; discussion 1142-3. doi: 10.1007/BF02234634.
There is a difference of opinion concerning the role of ileal pouch-anal anastomosis in Crohn's disease, even in the absence of small-bowel or perianal disease. One view is that ileal pouch-anal anastomosis should never be entertained, the other is that ileal pouch-anal anastomosis, like ileoproctostomy, can be justified sometimes, because it allows young people a period of stoma-free life. The aim of this study was to examine the outcome of ileal pouch-anal anastomosis and to contrast it with ileoproctostomy in patients with Crohn's disease without small-bowel or perianal disease.
Ileal pouch-anal anastomosis was performed in 23 patients with Crohn's disease (12 of whom had evidence of Crohn's disease at the time of operation and 11 who were eventually found to have Crohn's disease as a result of complications) and ileoproctostomy in 35. Patients were matched for age, gender, follow-up, and medication, but all ileoproctostomy cases had relative rectal sparing. Thus, the groups were not comparable and the reasons for ileal pouch-anal anastomosis and ileoproctostomy were therefore quite different.
The outcome in ileal pouch-anal anastomosis at a mean follow-up of 10.2 years was pouch excision, 11 (47.8 percent); proximal stoma, 1 (4.3 percent; patient preference); average small-bowel resection, 65 cm; persistent perineal sinus, 8 of 11 having pouch excision (73 percent); and mean time in hospital, 37 (range, 8-108) days. Of those in circuit having ileal pouch-anal anastomosis (n = 12), 24-hour bowel frequency was 6, with no incontinence or urgency, but 6 (50 percent) were on medication. When ileal pouch-anal anastomosis was done for Crohn's disease in the resection specimen, only 4 of 12 (33 percent) were excised compared with 7 of 11 (64 percent) in whom the diagnosis was made as a result of complications. The outcome in ileoproctostomy at a mean follow-up of 10.9 years was rectal excision in 3 (8 percent), proximal stoma in 1 (3 percent), average small-bowel resection was 15 cm, persistent perineal sinus in 1 (3 percent), and time in hospital was 21 (range, 8-36) days. Of those in circuit (n = 32), 24-hour bowel frequency was 5, 2 had incontinence, 3 had urgency, and 12 (36 percent) were taking medication.
These results indicate that the overall outcome of ileal pouch-anal anastomosis is inferior to that of ileoproctostomy, especially if Crohn's disease was diagnosed as a result of complications. Nevertheless, the functional results of those with a successful outcome are comparable.
对于回肠储袋肛管吻合术在克罗恩病中的作用，即便在无小肠或肛周疾病的情况下，也存在不同观点。一种观点认为绝不应该考虑进行回肠储袋肛管吻合术，另一种观点则认为，与回肠直肠吻合术一样，回肠储袋肛管吻合术有时是合理的，因为它能让年轻人有一段时间无需造口生活。本研究的目的是探讨回肠储袋肛管吻合术的结果，并将其与无小肠或肛周疾病的克罗恩病患者的回肠直肠吻合术结果进行对比。
对23例克罗恩病患者施行回肠储袋肛管吻合术（其中12例在手术时已有克罗恩病证据，11例最终因并发症被诊断为克罗恩病），对35例患者施行回肠直肠吻合术。患者在年龄、性别、随访时间和用药方面进行了匹配，但所有回肠直肠吻合术病例均相对保留了直肠。因此，两组不具有可比性，回肠储袋肛管吻合术和回肠直肠吻合术的原因也截然不同。
回肠储袋肛管吻合术患者平均随访10.2年的结果为：储袋切除11例（47.8%）；近端造口1例（4.3%，患者意愿）；平均小肠切除65cm；11例中有8例（73%）在储袋切除后仍有持续性会阴窦；平均住院时间37天（范围8 - 108天）。接受回肠储袋肛管吻合术且肠道功能正常的患者（n = 12），24小时排便次数为6次，无大便失禁或急迫感，但6例（50%）需要用药。当在切除标本中诊断为克罗恩病而行回肠储袋肛管吻合术时，12例中仅4例（33%）进行了储袋切除，而因并发症确诊的11例中有7例（64%）进行了储袋切除。回肠直肠吻合术患者平均随访10.9年的结果为：直肠切除3例（8%），近端造口1例（3%），平均小肠切除15cm，持续性会阴窦1例（3%），住院时间21天（范围8 - 36天）。肠道功能正常的患者（n = 32），24小时排便次数为5次，2例有大便失禁，3例有急迫感，12例（36%）需要用药。
这些结果表明，回肠储袋肛管吻合术的总体结果不如回肠直肠吻合术，尤其是在因并发症而诊断为克罗恩病的情况下。然而，手术成功患者的功能结果具有可比性。
