Kelly K A
Department of Surgery, Mayo Clinic, Rochester, Minnesota 55905.
Am J Surg. 1992 Jan;163(1):5-11. doi: 10.1016/0002-9610(92)90244-l.
Three anal sphincter-saving operations--ileorectostomy, ileal pouch-anal anastomosis, and ileal pouch-distal rectal anastomosis--are currently being used in the surgical treatment of chronic ulcerative colitis. All three operations remove the disease, or most of it, and yet they maintain transanal defecation, reasonable fecal continence, and a satisfactory quality of life. All three avoid permanent abdominal ileostomy. Ileorectostomy is the easiest to perform, but it leaves residual disease in the remaining rectum and proximal anal canal that may cause symptoms and that may predispose the patient to cancer. In contrast, ileal pouch-anal anastomosis, although a more technically demanding procedure, totally eradicates the colitis. Its main drawbacks--frequent stooling, nocturnal fecal spotting, and pouchitis--are usually satisfactorily treated with loperamide hydrochloride and metronidazole. Ileal pouch-distal rectal anastomosis is somewhat easier to perform than ileal pouch-anal anastomosis and may result in less nocturnal fecal spotting. Like ileorectostomy, however, the operation leaves residual disease in the distal rectum and proximal anal canal. Considering all of these factors, the ileal pouch-anal operation is preferred today for most patients who require surgery for chronic ulcerative colitis.
目前，三种保留肛门括约肌的手术——回肠直肠吻合术、回肠储袋肛管吻合术和回肠储袋 - 直肠远端吻合术——正用于慢性溃疡性结肠炎的外科治疗。这三种手术都能切除病变组织，或大部分病变组织，并且都能保留经肛门排便功能，维持合理的大便节制能力和令人满意的生活质量。三种手术都避免了永久性腹部回肠造口术。回肠直肠吻合术操作最简单，但会在剩余直肠和肛管近端留下残余病变，可能引发症状，还可能使患者易患癌症。相比之下，回肠储袋肛管吻合术虽然技术要求更高，但能彻底根除结肠炎。其主要缺点——排便频繁、夜间粪便渗漏和储袋炎——通常用盐酸洛哌丁胺和甲硝唑就能得到满意治疗。回肠储袋 - 直肠远端吻合术比回肠储袋肛管吻合术稍易操作，夜间粪便渗漏可能也较少。然而，与回肠直肠吻合术一样，该手术会在直肠远端和肛管近端留下残余病变。综合考虑所有这些因素，对于大多数需要手术治疗慢性溃疡性结肠炎的患者来说，如今回肠储袋肛管手术是首选。
