Lovegrove R E, Symeonides P, Tekkis P P, Goodfellow P B, Shorthouse A J
Department of Biosurgery and Surgical Technology, Imperial College London, London, UK.
Colorectal Dis. 2008 Nov;10(9):916-24. doi: 10.1111/j.1463-1318.2008.01506.x. Epub 2008 Mar 18.
A single surgeon series on complications and functional outcomes following restorative proctocolectomy (RPC) is presented.
An ethically-approved database was used to collect data on all patients undergoing RPC at a single institution. Patient demographics, operative details, complications and functional outcomes were assessed. The impact of ileostomy omission on outcomes was also assessed.
Two hundred patients undergoing RPC between 1987 and 2006 were included. There were 122 (61.0%) males and the mean age at surgery was 37.6 years. A J pouch was constructed in 199 (99.5%) patients and an ileostomy omitted in 160 (80.0%). Since adopting a selective policy after the 36th consecutive patient in the series, only 9 (5.5%) patients have had an ileostomy constructed at the time of pouch construction. Complications occurred in 112 (56.3%) patients, with anastomotic stricture (20.6%) and pouchitis (28.6%) being the most common. Anastomotic stricture was more common in those patients receiving an ileostomy (43.6%vs 15.0%, P < 0.001), as were pouch-cutaneous fistulae (5.1%vs 0.6%, P = 0.039) and pelvic sepsis (15.4%vs 5.0%, P = 0.023). Functional outcomes were good, with median 24-h stool frequency of five motions at 1 year. There was increased urgency to defaecate which in part may be due to a significant decline in the use of antidiarrhoeal medication during follow up.
Selective omission of a covering ileostomy in most cases can produce good results following RPC with no increase in the risk of septic complications or pouch failure, and a decreased risk of anastomotic stricture, with maintenance of good function in the majority.
本文呈现了一项关于恢复性直肠结肠切除术（RPC）后并发症及功能结局的单外科医生系列研究。
使用一个经过伦理批准的数据库收集某单一机构所有接受RPC患者的数据。评估患者人口统计学资料、手术细节、并发症及功能结局。还评估了省略回肠造口术对结局的影响。
纳入了1987年至2006年间接受RPC的200例患者。其中男性122例（61.0%），手术时的平均年龄为37.6岁。199例（99.5%）患者构建了J形贮袋，160例（80.0%）省略了回肠造口术。自该系列中第36例患者后采用选择性策略以来，仅9例（5.5%）患者在构建贮袋时进行了回肠造口术。112例（56.3%）患者发生并发症，其中吻合口狭窄（20.6%）和贮袋炎（28.6%）最为常见。吻合口狭窄在接受回肠造口术的患者中更常见（43.6%对15.0%，P<0.001），贮袋皮肤瘘（5.1%对0.6%，P = 0.039）和盆腔脓毒症（15.4%对5.0%，P = 0.023）也是如此。功能结局良好，1年时24小时排便频率中位数为5次。排便紧迫感增加，部分原因可能是随访期间止泻药物的使用显著减少。
在大多数情况下，选择性省略保护性回肠造口术在RPC后可产生良好效果，不会增加感染性并发症或贮袋失败的风险，且吻合口狭窄风险降低，大多数患者功能良好。
