Teixeira Magaly Gemio, Ponte Adauto C Abreu da, Sousa Manuela, Almeida Maristela G de, Silva Filho Edésio, Calache João Elias, Habr-Gama Angelita, Kiss Desidério R
Division of Coloproctology, Hospital das Clínicas, Faculty of Medicine, University of São Paulo, São Paulo/SP, Brazil.
Rev Hosp Clin Fac Med Sao Paulo. 2003 Jul-Aug;58(4):193-8. doi: 10.1590/s0041-87812003000400002. Epub 2003 Sep 30.
Ileal pouch-anal anastomosis was an important advancement in the treatment of ulcerative colitis. The aim of this study was to determine whether early complications of ileal pouch-anal anastomosis in patients with ulcerative colitis are associated with poor late functional results.
Eighty patients were operated on from 1986 to 2000, 62 patients with ileostomy and 18 without. The early and late complications were recorded. Specific emphasis has been placed on the incidence of pouchitis with prolonged follow-up.
The ileostomy was closed an average of 9.2 months after the first operation. Fourteen patients were excluded from the long-term evaluation; 6 patients were lost to regular follow-up, 4 died, and 4 patients still have the ileostomy. Of the 4 patients that died, 1 died from surgical complications. Early complications after operation (41) occurred in 34 patients (42.5%). Late complications (29) occurred in 25 patients as follows: 16 had pouchitis, 3 associated with stenosis and 1 with sexual dysfunction; 5 had stenosis; and there was 1 case each of incisional hernia, ileoanal fistula, hepatic cancer, and endometriosis. Pouchitis occurred in 6 patients (9.8%) 1 year after ileal pouch-anal anastomosis, 9 (14.8%) after 3 years, 13 (21.3%) after 5 years, and 16 (26.2%) after more than 6 years. The mean daily stool frequency was 12 before and 5.8 after operation. One pouch was removed because of fistulas that appeared 2 years later.
Ileal pouch-anal anastomosis is associated with a considerable number of early complications. There was no correlation between pouchitis and severe disease, operation with or without ileostomy, or early postoperative complications. The incidence of pouchitis was directly proportional to duration of time of follow-up.
回肠袋肛管吻合术是溃疡性结肠炎治疗中的一项重要进展。本研究的目的是确定溃疡性结肠炎患者回肠袋肛管吻合术的早期并发症是否与晚期功能结果不佳相关。
1986年至2000年对80例患者进行了手术，其中62例行回肠造口术，18例未行。记录了早期和晚期并发症。长期随访中特别关注了袋炎的发生率。
首次手术后平均9.2个月关闭回肠造口。14例患者被排除在长期评估之外；6例失访，4例死亡，4例仍保留回肠造口。在死亡的4例患者中，1例死于手术并发症。术后早期并发症（41例）发生在34例患者（42.5%）中。晚期并发症（29例）发生在25例患者中，情况如下：16例有袋炎，3例伴有狭窄，1例伴有性功能障碍；5例有狭窄；切口疝、回肠肛管瘘、肝癌和子宫内膜异位症各1例。回肠袋肛管吻合术后1年，6例患者（9.8%）发生袋炎，3年时9例（14.8%），5年时13例（21.3%），6年以上时16例（26.2%）。术前平均每日排便次数为12次，术后为5.8次。1个肠袋因2年后出现的瘘管而被切除。
回肠袋肛管吻合术伴有相当数量的早期并发症。袋炎与严重疾病、是否行回肠造口术、术后早期并发症之间无相关性。袋炎的发生率与随访时间直接相关。
