Jagelman D G
Department of Colorectal Surgery, Cleveland Clinic Florida.
Hepatogastroenterology. 1991 Dec;38(6):535-7.
Familial adenomatous polyposis is a generalized growth disorder. The predominant cause of death is, however, colorectal cancer in the untreated patient. Prophylactic colectomy, whether it be proctocolectomy and ileostomy, colectomy with ileorectal anastomosis, or colectomy with an ileoanal pouch procedure, will dramatically reduce the mortality from large bowel cancer. It is important, however, to realize that because of the generalized nature of this condition and the possibility of developing extracolonic malignancy, the surgical approach chosen should not be considered one that will necessarily cure the disease. Colectomy with ileorectal anastomosis still leaves the potential for rectal cancer. However, death from rectal cancer is distinctly uncommon. The risk of death following ileorectal anastomosis from rectal cancer is actually less than the risk of dying from cancer of the duodenum or from desmoid tumors. Both of these lesions are unpredictable in patients with familial adenomatous polyposis, and usually occur following the patient's prophylactic colectomy. With this low incidence of death from rectal cancer following ileorectal anastomosis it would seem to be debatable whether the complexities of the ileoanal pouch procedure together with its longer recovery and higher complication rate are justified in the routine management of young people with an early diagnosis of familial adenomatous polyposis.
家族性腺瘤性息肉病是一种全身性生长障碍。然而，未经治疗的患者主要死因是结直肠癌。预防性结肠切除术，无论是直肠结肠切除术加回肠造口术、结肠切除术加回肠直肠吻合术，还是结肠切除术加回肠肛管袋手术，都将显著降低大肠癌的死亡率。然而，必须认识到，由于这种疾病的全身性以及发生结肠外恶性肿瘤的可能性，所选择的手术方式不一定能治愈该疾病。回肠直肠吻合术式的结肠切除术仍有发生直肠癌的可能性。然而，死于直肠癌的情况明显罕见。回肠直肠吻合术后因直肠癌死亡的风险实际上低于死于十二指肠癌或硬纤维瘤的风险。在家族性腺瘤性息肉病患者中，这两种病变都无法预测，且通常发生在患者接受预防性结肠切除术后。鉴于回肠直肠吻合术后直肠癌的死亡率较低，对于早期诊断为家族性腺瘤性息肉病的年轻人，常规治疗中回肠肛管袋手术的复杂性及其更长的恢复时间和更高的并发症发生率是否合理，似乎值得商榷。
