Gorgun Emre, Remzi Feza H, Goldberg Jeffrey M, Thornton Julie, Bast Jane, Hull Tracy L, Loparo Bridget, Fazio Victor W
Department of Colorectal Surgery, Cleveland Clinic Foundation, Cleveland, OH 44195, USA.
Surgery. 2004 Oct;136(4):795-803. doi: 10.1016/j.surg.2004.06.018.
Restorative proctocolectomy and ileal pouch anal anastomosis (RP/IPAA) has become the gold standard surgical therapy for the majority of patients with mucosal ulcerative colitis and familial adenomatous polyposis. The aims of this study were to evaluate the fertility rates before and after RP/IPAA, to compare them with the reproductive data of the general United States population, and to determine surgical parameters that might influence subsequent fertility.
Three hundred women of reproductive age who underwent RP/IPAA between 1983 and 2001 completed a mailed questionnaire regarding their reproductive function before and after the procedure. Additional information was obtained from the pelvic pouch database. The reproductive information was compared to age-matched historical control subjects from the United States general population. The associations between changes in fertility and surgical parameters were also investigated.
The median (25th, 75th percentile) age at surgery was 28 (24, 33) years. Out of 300 women, 206 attempted to conceive. Before operation, 48 (38%) of 127 patients were unsuccessful after 1 year of unprotected intercourse, whereas after operation, 76 (56%) of 135 patients were unsuccessful. This infertility rate was higher after operation than before (P <.001). For the subgroup of 56 women who tried to get pregnant both before and after operation, the infertility rate was higher after operation than before (69% vs 46%; P=.005). Also, a higher percentage of these patients who had an intraoperative transfusion were infertile after operation compared to patients who did not have an intraoperative transfusion (54% vs 21%; P=.023).
There was an increase in the infertility rate after RP/IPAA. Intraoperative blood transfusion had a negative impact on the fertility rate after operation in patients who tried to conceive both before and after RP/IPAA.
保留直肠全结肠切除术及回肠储袋肛管吻合术（RP/IPAA）已成为大多数黏膜溃疡性结肠炎和家族性腺瘤性息肉病患者的金标准手术治疗方法。本研究的目的是评估RP/IPAA术前和术后的生育率，将其与美国普通人群的生殖数据进行比较，并确定可能影响后续生育能力的手术参数。
1983年至2001年间接受RP/IPAA手术的300名育龄妇女完成了一份关于手术前后生殖功能的邮寄问卷。从盆腔储袋数据库中获取了更多信息。将生殖信息与来自美国普通人群的年龄匹配的历史对照受试者进行比较。还研究了生育能力变化与手术参数之间的关联。
手术时的中位（第25、75百分位数）年龄为28（24，33）岁。在300名女性中，206人尝试怀孕。术前，127名患者中有48名（38%）在无保护性交1年后未成功受孕，而术后，135名患者中有76名（56%）未成功受孕。术后的不孕率高于术前（P<.001）。对于术前和术后都尝试怀孕的56名女性亚组，术后的不孕率高于术前（69%对46%；P=.005）。此外，与未进行术中输血的患者相比，这些术中输血的患者术后不孕的比例更高（54%对21%；P=.023）。
RP/IPAA术后不孕率增加。术中输血对术前和术后都尝试怀孕的患者术后生育率有负面影响。
