Sutter P M, Schuppisser J P, Ackermann C, Herzog U, Tondelli P
Chirurgische Abteilung, St. Claraspital Basel.
Schweiz Med Wochenschr. 1991 May 18;121(20):741-3.
Between 1984 and 1989 21 patients underwent proctocolectomy and were reconstructed with ileal-pouch-anal anastomosis using a J-pouch. 18 patients had ulcerative colitis and 3 adenoma of the colon. In 16 of 21 patients the operation was performed in a three-stage way: (1.) total colectomy; (2.) proctomucosectomy, ileal-pouch-anal anastomosis and protective ileostomy; (3.) ileostomy closure. 5 patients had a two-stage operation (3 patients with adenoma of the colon, 2 patients with low or no steroid medication). Operative mortality was 0%. Complications were seen in 4 of 21 patients after colectomy (sepsis, pelvic abscess in 2 instances, ileus), in 4 of 21 patients after ileal-pouch-anal anastomosis (pouch-vaginal fistula, pelvic abscess, anastomotic stricture, ileus) and in 2 of 19 patients after closure of ileostomy (pouch-vaginal fistula). In 19 of 21 patients the ileostomy is closed. All of these patients are fully continent during the day and only 2 patients are slightly incontinent at night. The average stool evacuation is 4 to 5 during the day and once to twice at night. All patients are very satisfied with the result.
1984年至1989年间，21例患者接受了直肠结肠切除术，并采用J形贮袋进行回肠贮袋肛管吻合术重建。18例患者患有溃疡性结肠炎，3例患有结肠腺瘤。21例患者中有16例分三期进行手术：（1）全结肠切除术；（2）直肠黏膜切除术、回肠贮袋肛管吻合术及保护性回肠造口术；（3）回肠造口关闭术。5例患者接受了两期手术（3例结肠腺瘤患者，2例使用低剂量或未使用类固醇药物的患者）。手术死亡率为0%。结肠切除术后，21例患者中有4例出现并发症（脓毒症、2例盆腔脓肿、肠梗阻）；回肠贮袋肛管吻合术后，21例患者中有4例出现并发症（贮袋阴道瘘、盆腔脓肿、吻合口狭窄、肠梗阻）；回肠造口关闭术后，19例患者中有2例出现并发症（贮袋阴道瘘）。21例患者中有19例回肠造口已关闭。所有这些患者白天排便完全正常，只有2例患者夜间稍有失禁。白天平均排便4至5次，夜间1至2次。所有患者对结果都非常满意。
