Akbari Robert P, Madoff Robert D, Parker Susan C, Hagerman Gonzalo, Minami Shigeki, Bullard Dunn Kelli M, Mellgren Anders F
Department of Surgery, Division of Colon & Rectal Surgery, University of Minnesota, Minneapolis, Minnesota, USA.
Dis Colon Rectum. 2009 Mar;52(3):452-5. doi: 10.1007/DCR.0b013e31819a20e0.
This study was designed to analyze the incidence, management, and outcome of pouch sinuses after ileal pouch-anal anastomosis at one institution.
We identified 282 ileal pouch-anal anastomosis patients between 1992 and 2002 who had a pouchogram before planned ileostomy closure. The management and outcome of patients with pouchograms revealing pouch sinuses were reviewed.
Twenty-two patients (7.8 percent) had a pouch sinus at pouchogram. Nineteen patients were observed and underwent repeat pouchogram. Of these, ten had sinus resolution (mean, 3.6 months) and underwent successful ileostomy closure. Eight patients underwent examination under anesthesia +/- sinus debridement. Six of these patients had subsequent pouchograms with five showing sinus resolution. The patient without resolution was not reversed. Of the eight patients who underwent examination under anesthesia +/- debridement, seven underwent ileostomy closure (mean, 4.9 months), with healing in six and pelvic sepsis in one. Four patients underwent successful ileostomy takedown despite persistent sinus. Overall, 21 of the 22 pouch sinus patients underwent ileostomy closure and only 1 had postoperative pelvic sepsis.
Pouch sinuses after ileal pouch-anal anastomosis with ileostomy are uncommon. Most heal within six months. The majority of patients with sinuses eventually undergo successful ileostomy closure. Pelvic septic complications are rare but can occur despite sinus healing on pouchogram.
本研究旨在分析某一机构中回肠贮袋肛管吻合术后贮袋窦道的发生率、处理方法及结果。
我们确定了1992年至2002年间282例行回肠贮袋肛管吻合术且在计划关闭回肠造口术前进行了贮袋造影的患者。对贮袋造影显示有贮袋窦道的患者的处理方法及结果进行了回顾。
22例患者（7.8%）在贮袋造影时发现有贮袋窦道。19例患者接受观察并进行了重复贮袋造影。其中，10例窦道消失（平均3.6个月）并成功关闭了回肠造口。8例患者接受了麻醉下检查及±窦道清创术。这些患者中有6例随后进行了贮袋造影，其中5例窦道消失。未消失的患者未进行回肠造口还纳。在接受麻醉下检查及±清创术的8例患者中，7例进行了回肠造口关闭（平均4.9个月），6例愈合，1例发生盆腔感染。4例患者尽管窦道持续存在但仍成功进行了回肠造口还纳。总体而言，22例贮袋窦道患者中有21例进行了回肠造口关闭，仅1例术后发生盆腔感染。
回肠贮袋肛管吻合术加回肠造口术后的贮袋窦道并不常见。大多数在6个月内愈合。大多数有窦道的患者最终成功关闭了回肠造口。盆腔感染并发症很少见，但尽管贮袋造影显示窦道愈合仍可能发生。
