Fazio Victor W, Tekkis Paris P, Remzi Feza, Lavery Ian C, Manilich Elena, Connor Jason, Preen Miriam, Delaney Conor P
Department of Colorectal Surgery, Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA.
Ann Surg. 2003 Oct;238(4):605-14; discussion 614-7. doi: 10.1097/01.sla.0000090940.39838.6a.
To identify risk factors associated with ileal pouch failure and to develop a multifactorial model for quantifying the risk of failure in individual patients. SUMMARY BACKGROUND DATA Ileal pouch anal anastomosis (IPAA) has become the treatment choice for most patients with ulcerative colitis and familial adenomatous polyposis who require surgery. At present, there are no published studies that investigate collectively the interrelation of factors related to ileal pouch failure, nor are there any predictive indices for risk stratification of patients undergoing IPAA surgery.
Data from 23 preoperative, 7 intraoperative, and 10 postoperative risk factors were recorded from 1,965 patients undergoing restorative proctocolectomy in a single center between 1983 and 2001. Primary end point was ileal pouch failure during the follow-up period of up to 19 years. The "CCF ileal pouch failure" model was developed using a parametric survival analysis and a 70%:30% split-sample validation technique for model training and testing.
The median patient follow-up was 4.1 year (range, 0-19 years). Five-year ileal pouch survival was 95.6% (95% CI, 94.4-96.7). The following risk factors were found to be independent predictors of pouch survival and were used in the final multivariate model: patient diagnosis, prior anal pathology, abnormal anal manometry, patient comorbidity, pouch-perineal or pouch-vaginal fistulae, pelvic sepsis, anastomotic stricture and separation. The model accurately predicted the risk of ileal pouch failure with adequate calibration statistics (Hosmer Lemeshow chi2 = 3.001; P = 0.557) and an area under the receiver operating characteristics curve of 82.0%.
The CCF ileal pouch failure model is a simple and accurate way of predicting the risk of ileal pouch failure in clinical practice on a longitudinal basis. It may play an important role in providing risk estimates for patients wishing to make informed choices on the type of treatment offered to them.
确定与回肠贮袋功能衰竭相关的危险因素，并建立一个多因素模型以量化个体患者的功能衰竭风险。总结背景数据 回肠贮袋肛管吻合术（IPAA）已成为大多数需要手术的溃疡性结肠炎和家族性腺瘤性息肉病患者的治疗选择。目前，尚无已发表的研究共同探讨与回肠贮袋功能衰竭相关因素之间的相互关系，也没有针对接受IPAA手术患者进行风险分层的预测指标。
记录了1983年至2001年间在单一中心接受保留性直肠结肠切除术的1965例患者的23项术前、7项术中及10项术后危险因素的数据。主要终点是长达19年随访期内的回肠贮袋功能衰竭。“CCF回肠贮袋功能衰竭”模型采用参数生存分析和70%:30%的样本分割验证技术进行模型训练和测试。
患者的中位随访时间为4.1年（范围0至19年）。回肠贮袋5年生存率为95.6%（95%可信区间，94.4 - 96.7）。发现以下危险因素是贮袋生存的独立预测因素，并用于最终的多变量模型：患者诊断、既往肛门病变、肛门测压异常、患者合并症、贮袋 - 会阴或贮袋 - 阴道瘘、盆腔感染、吻合口狭窄和分离。该模型通过充分的校准统计（Hosmer Lemeshow卡方 = 3.001；P = 0.557）和受试者工作特征曲线下面积为82.0%，准确预测了回肠贮袋功能衰竭的风险。结论：CCF回肠贮袋功能衰竭模型是在临床实践中纵向预测回肠贮袋功能衰竭风险的一种简单而准确的方法。它可能在为希望对所提供的治疗类型做出明智选择的患者提供风险评估方面发挥重要作用。
