Hyman N H, Fazio V W, Tuckson W B, Lavery I C
Cleveland Clinic Foundation, Department of Colorectal Surgery, Ohio 44195-5044.
Dis Colon Rectum. 1991 Aug;34(8):653-7. doi: 10.1007/BF02050345.
Patients with Crohn's colitis are generally not considered candidates for the ileal pouch-anal anastomosis (IPAA) procedure. We reviewed 362 consecutive patients undergoing IPAA and analyzed the outcome of this procedure on 25 patients with a preoperative diagnosis of mucosal ulcerative colitis who were subsequently proven to have Crohn's disease. The mean follow-up was 38.1 months. Sixteen patients have a functioning pouch, seven have required pouch excision, one is diverted, and one has died. Only one of nine patients in whom there was a preoperative clinical feature suggestive of Crohn's disease has a functioning pouch, with complications uniformly occurring within months of ileostomy closure. In contrast, 15 of 16 patients without preoperative features of Crohn's disease have maintained their pouch, generally with good results. These data suggest that patients in whom there is clinical and pathologic evidence of Crohn's disease do very poorly without meaningful symptom-free intervals. However, patients without any clinical features of Crohn's disease, despite a histopathologic diagnosis of Crohn's colitis, have had a good outcome with IPAA thus far.
克罗恩病性结肠炎患者一般不被视为回肠储袋肛管吻合术（IPAA）的候选对象。我们回顾了362例连续接受IPAA手术的患者，并分析了该手术对25例术前诊断为黏膜溃疡性结肠炎但随后被证实患有克罗恩病的患者的疗效。平均随访时间为38.1个月。16例患者的储袋功能良好，7例需要切除储袋，1例改道，1例死亡。术前临床特征提示克罗恩病的9例患者中，只有1例的储袋功能良好，并发症均在回肠造口关闭后的数月内出现。相比之下，16例术前无克罗恩病特征的患者中有15例保留了储袋，总体效果良好。这些数据表明，有克罗恩病临床和病理证据的患者如果没有有意义的无症状期，预后很差。然而，没有任何克罗恩病临床特征的患者，尽管组织病理学诊断为克罗恩病性结肠炎，但迄今为止IPAA手术的预后良好。
