Melton Genevieve B, Fazio Victor W, Kiran Ravi P, He Jin, Lavery Ian C, Shen Bo, Achkar Jean-Paul, Church James M, Remzi Feza H
Digestive Disease Institute, Department of Colorectal Surgery, Cleveland Clinic Foundation, Cleveland, OH 44195, USA.
Ann Surg. 2008 Oct;248(4):608-16. doi: 10.1097/SLA.0b013e318187ed64.
To assess long-term outcomes after ileal pouch-anal anastomosis (IPAA) in Crohn's disease (CD).
Although considered the procedure of choice in ulcerative colitis, performance of ileal pouch-anal anastomosis (IPAA) is controversial in CD.
CD patients were identified from a prospectively maintained IPAA database. Time-to-diagnosis and pouch retention rates were analyzed using Kaplan-Meier curves. Demographic, clinical, and pathologic factors associated with pouch retention were evaluated with log-rank test and Cox proportional hazards model.
Two hundred and four CD patients (108 female, median age 33 years, and median follow-up 7.4 years) with primary IPAA were included. CD diagnosis was before IPAA (intentional) in 20(10%), from postoperative histopathology (incidental) in 97(47%) or made in a delayed fashion at median 36 months after IPAA in 87(43%). Overall 10-year pouch retention was 71%. On multivariate analysis, pouch loss was associated with delayed diagnosis (P = 0.03, hazard ratio [HR] 2.6 (95% confidence interval [CI] 1.1-6.5)), pouch-vaginal fistula (P = 0.01, HR 2.8 (95% CI 1.3-6.4)), and pelvic sepsis (P = 0.0001, HR 9.7(95% CI 3.4-27.3)). Patients with retained IPAA at follow-up had near-perfect/perfect continence (72%), rare/no urgency (68%) with median daily bowel movements 7 (range 2-20). Median overall quality of life, quality of health, level of energy, and happiness with surgery were 9, 9, 8, and 10 of 10, respectively.
For CD patients with IPAA, when the diagnosis is established preoperatively or immediately following surgery, pouch loss rates are low and functional results are favorable. Outcomes in patients with delayed diagnosis are worse but half retain their pouch at 10 years with good functional outcomes.
评估克罗恩病（CD）患者回肠储袋肛管吻合术（IPAA）后的长期预后。
尽管回肠储袋肛管吻合术（IPAA）被认为是溃疡性结肠炎的首选术式，但在克罗恩病（CD）中该手术的应用仍存在争议。
从一个前瞻性维护的IPAA数据库中识别出CD患者。使用Kaplan-Meier曲线分析诊断时间和储袋保留率。采用对数秩检验和Cox比例风险模型评估与储袋保留相关的人口统计学、临床和病理因素。
纳入204例行初次IPAA的CD患者（108例女性，中位年龄33岁，中位随访7.4年）。20例（10%）患者在IPAA术前（有意）诊断为CD，97例（47%）患者术后组织病理学检查（偶然）确诊，87例（43%）患者在IPAA术后中位36个月延迟诊断。总体10年储袋保留率为71%。多因素分析显示，储袋丢失与诊断延迟（P = 0.03，风险比[HR] 2.6（95%置信区间[CI] 1.1 - 6.5））、储袋阴道瘘（P = 0.01，HR 2.8（95% CI 1.3 - 6.4））和盆腔脓毒症（P = 0.0001，HR 9.7（95% CI 3.4 - 27.3））相关。随访中保留IPAA的患者控便情况近乎完美/完美（72%），很少/无便急（68%），每日排便中位数为7次（范围2 - 20次）。总体生活质量、健康质量、精力水平和对手术的满意度中位数分别为9分、9分、8分和10分（满分10分）。
对于行IPAA的CD患者，若术前或术后立即确诊，储袋丢失率低且功能预后良好。诊断延迟患者的预后较差，但10年时仍有半数患者保留储袋且功能预后良好。
