Barry M, Mealy K, Hyland J
Department of Surgery, St. Vincent's Hospital, Dublin.
Ir J Med Sci. 1992 Sep;161(9):559-60. doi: 10.1007/BF02940558.
Restorative proctocolectomy is now the treatment of choice for most patients with ulcerative colitis and familial polyposis coli. Temporary defunctioning ileostomy has been advocated during the period of anastomotic healing to prevent pelvic sepsis. However, the ileostomy itself may be a source of significant complications. To examine ileostomy function we reviewed thirty five patients (mean age 34.5 +/- 1.95 years) who underwent restorative proctocolectomy. Thirty four patients had a defunctioning ileostomy established at the time of pouch anal anastomosis. Closure of the ileostomy has been carried out in 33 patients (mean closure time 3.1 +/- 0.29 months). One patient underwent early pouch excision. Thirteen of the 35 patients developed post-operative complications (37%), two directly related to the defunctioning ileostomy. Both occurred following closure of the stoma and required laparotomy. Serious complications associated with defunctioning ileostomy as demonstrated in this study are uncommon (8.5%). Given the potentially disastrous consequences of a pouch-anal anastomotic leak we feel that the relatively low morbidity associated with a defunctioning ileostomy justifies its continued routine usage in the operation of restorative proctocolectomy.
全结肠直肠切除回肠储袋肛管吻合术目前是大多数溃疡性结肠炎和家族性结肠息肉病患者的首选治疗方法。在吻合口愈合期间提倡行暂时性失功性回肠造口术，以预防盆腔感染。然而，回肠造口术本身可能是严重并发症的一个来源。为了研究回肠造口术的功能，我们回顾了35例行全结肠直肠切除回肠储袋肛管吻合术的患者（平均年龄34.5±1.95岁）。34例患者在回肠储袋肛管吻合术时行了失功性回肠造口术。33例患者已关闭回肠造口（平均关闭时间3.1±0.29个月）。1例患者早期切除了回肠储袋。35例患者中有13例发生术后并发症（37%），其中2例与失功性回肠造口术直接相关。均发生在造口关闭后，需要开腹手术。本研究中所显示的与失功性回肠造口术相关的严重并发症并不常见（8.5%）。鉴于回肠储袋肛管吻合口漏可能带来灾难性后果，我们认为失功性回肠造口术相关的相对较低的发病率证明了其在全结肠直肠切除回肠储袋肛管吻合术操作中继续常规使用的合理性。
