Penna C P, Tiret E, Kartheuser A H, Frileux P, Hannoun L, Nordlinger B, Parc R
Service de Chirurgie Digestive, Hôpital Saint-Antoine, Paris.
Gastroenterol Clin Biol. 1992;16(5):401-5.
The aim of this study was to compare the functional results of ileo-rectal anastomosis and ileal pouch-anal anastomosis in a group of patients with familial adenomatous polyposis who had conversion of a ileorectostomy into a ileal pouch-anal anastomosis. In 2 cases (8.3 percent), the conversion was impossible because of abdominal desmoid tumors. For the remaining 21 patients, with more than 1 year follow-up, the number of bowel movements per 24 hours was 3.8 +/- 0.2 before and 4.6 +/- 0.3 after conversion. Daytime and nighttime continence and sensation of the need to defecate were unchanged. The number of patients having nocturnal bowel movements were higher after the pouch procedure (40 vs 10.5 percent). After ileorectostomy and after conversion, 89.5 and 80 percent of the patients had good functional results respectively. Ninety percent of the patients said that results were unchanged or improved after the conversion. In familial adenomatous polyposis the functional results of ileal pouch-anal anastomosis are similar to those of ileorectostomy but the first procedure eradicates the risk of rectal cancer. A conversion to ileal pouch-anal anastomosis should to be proposed to patients with ileorectostomy and at high risk for rectal cancer.
本研究的目的是比较一组家族性腺瘤性息肉病患者中，回肠直肠吻合术与回肠储袋肛管吻合术的功能结果，这些患者已将回肠直肠吻合术转换为回肠储袋肛管吻合术。2例（8.3%）患者因腹部硬纤维瘤而无法进行转换。其余21例患者随访1年以上，转换前每24小时排便次数为3.8±0.2次，转换后为4.6±0.3次。白天和夜间的控便能力以及排便需求感觉未发生变化。行储袋手术后夜间排便的患者数量更多（40%对10.5%）。回肠直肠吻合术后和转换后，分别有89.5%和80%的患者功能结果良好。90%的患者表示转换后结果未变或有所改善。在家族性腺瘤性息肉病中，回肠储袋肛管吻合术的功能结果与回肠直肠吻合术相似，但前者消除了直肠癌风险。对于行回肠直肠吻合术且患直肠癌风险较高的患者，应建议其转换为回肠储袋肛管吻合术。
