Tajika Masahiro, Nakamura Tuneya, Nakahara Osamu, Kawai Hiroki, Komori Kouji, Hirai Takashi, Kato Tomoyuki, Bhatia Vikram, Baba Hideo, Yamao Kenji
Department of Endoscopy, Aichi Cancer Center Hospital, 1-1 Kanokoden, Chikusa-ku, Nagoya, 464-8681, Japan.
J Gastrointest Surg. 2009 Jul;13(7):1266-73. doi: 10.1007/s11605-009-0871-1. Epub 2009 Mar 31.
Restorative proctocolectomy has become the most common surgical option for patients with familial adenomatous polyposis (FAP). However, adenomas may develop in the ileal pouch mucosa over time, and even carcinoma in the pouch has been reported. Our aim was to evaluate the prevalence, nature, and etiology of ileal pouch and nonpouch adenomas and carcinoma in patients with FAP.
This was a retrospective study of 31 FAP patients with Kock's continent ileostomy (Kock; n = 8), ileorectal anastomosis (IRA; n = 7), and ileal pouch-anal anastomosis (IPAA) (n = 16). All patients were followed with a standardized protocol including chromoendoscopy and biopsies of visible polyps in the ileal pouch and nonpouch mucosa.
Sixteen of 24 pouch patients (Kock and IPAA) developed adenomas in the ileal pouch mucosa, and all patients with IRA developed adenomas in the rectal mucosa. The prevalence of ileal adenomas was significantly higher in pouch patients than in IRA patients (P = 0.002). Only one patient with Kock showed adenoma in the prepouch area. Two cases of adenocarcinomas and one case of advanced adenoma were found in the ileal pouch mucosa.
Our results show a high frequency of adenomas in the ileal pouch mucosa, with evolution into carcinoma in some patients. Regular endoscopic surveillance of the pouch is recommended at a frequency similar to that for the rectal mucosa after IRA in pouch patients with FAP.
保留直肠的结肠切除术已成为家族性腺瘤性息肉病（FAP）患者最常见的手术选择。然而，随着时间的推移，回肠储袋黏膜可能会出现腺瘤，甚至有报道称储袋内发生了癌。我们的目的是评估FAP患者回肠储袋及非储袋腺瘤和癌的发生率、性质及病因。
这是一项对31例FAP患者的回顾性研究，这些患者分别接受了Kock可控性回肠造口术（Kock；n = 8）、回肠直肠吻合术（IRA；n = 7）和回肠储袋肛管吻合术（IPAA）（n = 16）。所有患者均按照标准化方案进行随访，包括对回肠储袋和非储袋黏膜中可见息肉进行色素内镜检查和活检。
24例接受储袋手术的患者（Kock术和IPAA术）中有16例在回肠储袋黏膜中出现腺瘤，所有接受IRA术的患者在直肠黏膜中出现腺瘤。储袋患者回肠腺瘤的发生率显著高于IRA患者（P = 0.002）。只有1例接受Kock术的患者在储袋前区域出现腺瘤。在回肠储袋黏膜中发现2例腺癌和1例高级别腺瘤。
我们的结果显示回肠储袋黏膜中腺瘤的发生率很高，部分患者会进展为癌。建议对FAP储袋患者进行定期内镜监测，监测频率与IRA术后直肠黏膜的监测频率相似。
