Oncel M, Remzi F H, Church J M, Connor J T, Fazio V W
Department of Colorectal Surgery, Cleveland Clinic Foundation, Cleveland 44195, USA.
Colorectal Dis. 2004 Sep;6(5):332-5. doi: 10.1111/j.1463-1318.2004.00623.x.
Laparotomy is the treatment of choice in Peutz-Jeghers Syndrome (PJS) patients for endoscopically irretrievable symptomatic polyps and polyp-related complications. During the last decade, we have operated on majority of the PJS patients with the purpose of removing all the gastrointestinal polyps (clean sweep), when an operation was indicated. The aim of this study is to evaluate the effect of clean sweep technique on the need for repeated surgery compared to a problem focused approach.
All patients with PJS treated in our institution since 1964 were studied. They were placed into two groups; those who had a problem-focused operation and those who were operated with the purpose of removing all small and large intestinal polyps. Demographics, presentation, follow-up period and the need for recurrent surgery were compared.
We identified 11 patients (4 males, 7 females). Eight patients (5 females; median age 18.5) had problem-focused surgery for bleeding-anaemia (n = 3) or obstruction-intussusception (n = 5). These patients required 23 further operations within 87 patient-follow-up-years (2.64 operations per 10 years). Three patients (2 females; median age 6) were operated for bleeding-anaemia (n = 1) or obstruction-intussusception (n = 2) using the 'clean sweep' approach. These patients did not require any further surgery within 21 patient-follow-up-years. The gender, presentation and follow-up periods were similar between the groups. However, the 'clean sweep' technique appears to have reduced the need for further operations when it is compared with problem-focused approach (P = 0.01).
To reduce the need for abdominal surgery and consequent problems in PJS patients, an attempt to remove all detected polyps (clean sweep technique) may be beneficial in these patients.
对于黑斑息肉综合征（PJS）患者，剖腹手术是治疗内镜无法取出的有症状息肉及息肉相关并发症的首选方法。在过去十年中，当有手术指征时，我们对大多数PJS患者进行手术，目的是切除所有胃肠道息肉（彻底清除）。本研究的目的是评估与针对问题的方法相比，彻底清除技术对再次手术需求的影响。
对自1964年以来在我们机构接受治疗的所有PJS患者进行研究。他们被分为两组；一组接受针对问题的手术，另一组接受旨在切除所有小肠和大肠息肉的手术。比较两组的人口统计学、临床表现、随访期及再次手术的需求。
我们确定了11例患者（4例男性，7例女性）。8例患者（5例女性；中位年龄18.5岁）因出血性贫血（n = 3）或梗阻性肠套叠（n = 5）接受了针对问题的手术。这些患者在87个患者随访年期间需要23次进一步手术（每10年2.64次手术）。3例患者（2例女性；中位年龄6岁）因出血性贫血（n = 1）或梗阻性肠套叠（n = 2）采用“彻底清除”方法进行手术。这些患者在21个患者随访年期间不需要任何进一步手术。两组之间的性别、临床表现和随访期相似。然而，与针对问题的方法相比，“彻底清除”技术似乎减少了进一步手术的需求（P = 0.01）。
为减少PJS患者腹部手术的需求及随之而来的问题，尝试切除所有检测到的息肉（彻底清除技术）可能对这些患者有益。
