Takagi Kazutoshi, Nagata Hitoshi, Ishizuka Mitsuru, Sakuraoka Yuki, Kubota Keiichi
Department of Gastroenterological Surgery, Dokkyo University School of Medicine, Kitakobayashi, Mibu, Shimotsuga, Tochigi, Japan.
Surg Laparosc Endosc Percutan Tech. 2008 Oct;18(5):486-8. doi: 10.1097/SLE.0b013e318180812a.
Restorative proctocolectomy and J-shaped ileal pouch-anal anastomosis have been performed as a standard operation for ulcerative colitis. However, functional problems are sometimes troublesome in the postoperative period. The J pouch was constructed from 2 ileal limbs using the gastrointestinal anastomosis (GIA) stapler. A residual mucosal bridge remained because the stapler had a safety margin at the top of the cartridge. Apical pouch bridge is a residual septum above the ileoanal anastomosis. There are several reports of so-called apical pouch bridge syndrome due to outlet obstruction of the J-shaped ileal pouch by an apical bridge. Division of this septum can resolve the outlet obstruction. We describe a successful endoscopic procedure for division of an apical pouch bridge. An Endo-GIA stapler was introduced into the ileal pouch alongside the endoscope, and division of the apical bridge required a few firings of the Endo-GIA stapler under transanal endoscopic guidance. The symptoms related to the apical pouch bridge were resolved completely without creation of an ileostomy.
全结直肠切除回肠J形贮袋肛管吻合术已作为溃疡性结肠炎的标准术式开展。然而，术后功能问题有时颇为棘手。J形贮袋由2个回肠肠段使用胃肠吻合（GIA）吻合器构建而成。由于吻合器在钉仓顶部有安全边缘，故而残留了黏膜桥。顶端贮袋桥是回肠肛管吻合口上方的残留隔膜。有若干关于顶端桥导致J形回肠贮袋出口梗阻所致所谓顶端贮袋桥综合征的报道。切开此隔膜可解除出口梗阻。我们描述了一种成功的内镜下切开顶端贮袋桥的手术方法。将Endo-GIA吻合器经肛门内镜引导下与内镜一起插入回肠贮袋，切开顶端桥需要使用Endo-GIA吻合器击发数次。与顶端贮袋桥相关的症状完全缓解，未行回肠造口术。
