Beveridge Iain G, Swain David J W, Groves Chris J, Saunders Brian P, Windsor Alastair C, Talbot Ian C, Nicholls R John, Phillips Robin K S
Polyposis Registry, Cancer Research UK Colorectal Cancer Unit, St Mark's Hospital, Northwick Park, Harrow, UK.
Dis Colon Rectum. 2004 Jan;47(1):123-6. doi: 10.1007/s10350-003-0020-y. Epub 2004 Jan 14.
A restorative proctocolectomy or ileal pouch procedure is one of the main surgical options for patients with familial adenomatous polyposis. The main premise underlying the recommendation of a pouch procedure rather than an ileorectal anastomosis is that it minimizes the risk of rectal cancer. Several studies have evaluated the risk of developing pouch adenomas. There also have been reports of pouch cancers, although the long-term risk of malignancy cannot yet be quantified. Most pouch polyps reported have been small tubular adenomas with mild dysplasia. A 19-year-old female with familial adenomatous polyposis had a colectomy and ileorectal anastomosis. Progressive rectal polyposis led to a restorative proctocolectomy at aged 38 years. Four years later, a large, 3-cm x 2-cm, villous adenoma was identified in the mid pouch, which was resected endoscopically. A 32-year-old male with familial adenomatous polyposis had a restorative proctocolectomy. Ten years after surgery, pouch endoscopy revealed several large, villous adenomas arising from the pouch mucosa. These advanced polyps may present a significant risk for cancer development and require close endoscopic surveillance. These findings strengthen the recommendation for careful regular endoscopic surveillance of familial adenomatous polyposis pouches and the evaluation of management and treatment strategies for pouch adenomas.
全直肠系膜切除回肠储袋肛管吻合术是家族性腺瘤性息肉病患者的主要手术选择之一。推荐采用储袋手术而非回肠直肠吻合术的主要前提是，它能将直肠癌风险降至最低。多项研究评估了发生储袋腺瘤的风险。也有储袋癌的报道，尽管恶性肿瘤的长期风险尚无法量化。报道的大多数储袋息肉为轻度发育异常的小的管状腺瘤。一名19岁的家族性腺瘤性息肉病女性患者接受了结肠切除术和回肠直肠吻合术。进行性直肠息肉病导致其在38岁时接受了全直肠系膜切除回肠储袋肛管吻合术。四年后，在储袋中部发现一个3厘米×2厘米的大绒毛状腺瘤，通过内镜切除。一名32岁的家族性腺瘤性息肉病男性患者接受了全直肠系膜切除回肠储袋肛管吻合术。术后十年，储袋内镜检查发现储袋黏膜出现几个大的绒毛状腺瘤。这些进展期息肉可能对癌症发生构成重大风险，需要密切的内镜监测。这些发现强化了对家族性腺瘤性息肉病储袋进行仔细定期内镜监测以及评估储袋腺瘤管理和治疗策略的建议。
