Ayrizono Maria de Lourdes Setsuko, Meirelles Luciana Rodrigues, Leal Raquel Franco, Coy Cláudio Saddy Rodrigues, Fagundes João José, Góes Juvenal Ricardo Navarro
Grupo de Coloproctologia, Departamento de Cirurgia e Departamento de Anatomia Patológica, Faculdade de Ciências Médicas, Universidade Estadual de Campinas, Campinas, São Paulo, SP, Brazil.
Arq Gastroenterol. 2008 Jul-Sep;45(3):204-7. doi: 10.1590/s0004-28032008000300007.
Total rectocolectomy and ileal pouch-anal anastomosis is the choice surgical procedure for patients with ulcerative colitis. In cases of Crohn's disease post-operative diagnosis, it can be followed by pouch failure.
To evaluate ileal pouch-anal anastomosis long-term outcome in patients with Crohn's disease.
Between February 1983 and March 2007, 151 patients were submitted to ileal pouch-anal anastomosis by Campinas State University Colorectal Unit, Campinas, SP, Brazil, 76 had pre-operative ulcerative colitis diagnosis and 11 had post-operative Crohn's disease diagnosis. Crohn's disease diagnosis was made by histopathological biopsies in nine cases, being one in surgical specimen, two cases in rectal stump, small bowel in two cases, ileal pouch in three and in perianal abscess in one of them. The median age was 30.6 years and eight (72.7%) were female.
All patients had previous ulcerative colitis diagnosis and in five cases emergency colectomy was done by toxic megacolon. The mean time until of Crohn's disease diagnosis was 30.6 (6-80) months after ileal pouch-anal anastomosis. Ileostomy closure was possible in 10 cases except in one that had ileal pouch fistula, perianal disease and small bowel involvement. In the long-term follow-up, three patients had perineal fistulas and one had also a pouch-vaginal fistula. All of them were submitted to a new ileostomy and one had the pouch excised. Another patient presented pouch-vaginal fistula which was successfully treated by mucosal flap. Three patients had small bowel involvement and three others, pouch involvement. All improved with medical treatment. Presently, the mean follow-up is 76.5 months and all patients are in clinical remission, and four have fecal diversion. The remaining patients have good functional results with 6-10 bowel movements/day.
Crohn's disease diagnosis after ileal pouch-anal anastomosis for ulcerative colitis may be usual and later complications such fistulas and stenosis are common. However, when left in situ ileal pouch is associated with good function.
全直肠结肠切除术及回肠储袋肛管吻合术是溃疡性结肠炎患者的首选手术方式。对于克罗恩病患者，术后诊断可能会导致储袋功能衰竭。
评估克罗恩病患者回肠储袋肛管吻合术的长期疗效。
1983年2月至2007年3月期间，巴西圣保罗州坎皮纳斯市坎皮纳斯州立大学结直肠科为151例患者实施了回肠储袋肛管吻合术，其中76例术前诊断为溃疡性结肠炎，11例术后诊断为克罗恩病。9例克罗恩病的诊断通过组织病理学活检确定，其中1例在手术标本中，2例在直肠残端，2例在小肠，3例在回肠储袋，1例在肛周脓肿。患者中位年龄为30.6岁，8例（72.7%）为女性。
所有患者既往均诊断为溃疡性结肠炎，5例因中毒性巨结肠行急诊结肠切除术。回肠储袋肛管吻合术后至克罗恩病诊断的平均时间为30.6（6 - 80）个月。除1例有回肠储袋瘘、肛周疾病和小肠受累的患者外，10例患者可行回肠造口关闭术。在长期随访中，3例患者出现会阴瘘，1例还出现储袋阴道瘘。所有这些患者均接受了新的回肠造口术，1例患者切除了储袋。另1例患者出现储袋阴道瘘，经黏膜瓣成功治疗。3例患者小肠受累，3例储袋受累。所有患者经药物治疗后病情均有改善。目前，平均随访时间为76.5个月，所有患者均处于临床缓解期，4例患者有粪便转流。其余患者功能良好，每天排便6 - 10次。
溃疡性结肠炎患者行回肠储袋肛管吻合术后诊断为克罗恩病可能较为常见，后期并发症如瘘和狭窄也很常见。然而，保留原位的回肠储袋功能良好。
