Carter F M, McLeod R S, Cohen Z
Division of General Surgery, Toronto General Hospital, Ontario, Canada.
Dis Colon Rectum. 1991 Nov;34(11):1005-9. doi: 10.1007/BF02049965.
Complications related to the retained rectal remnant were reviewed in 136 patients undergoing subtotal colectomy for acute ulcerative colitis. Fifty-five patients (Group 1) had a closed rectal stump brought up into the subcutaneous tissue, and 30 (Group 2) had an open mucous fistula. These were compared with an intrapelvic Hartmann's pouch performed in 51 patients (Group 3). All patients eventually had a pelvic pouch procedure. Age, duration and activity of disease, and preoperative steroid use were similar in all groups. There was no mortality. The rectal stump in 19 Group 1 patients (35 percent) spontaneously opened, and seven (13 percent) developed local left lower quadrant wound infections. Two Group 1 patients (4 percent) developed pelvic septic complications, as compared with two Group 2 patients (7 percent) and six Group 3 patients (12 percent). Subsequent pelvic dissection was difficult in 20 percent of Group 3 patients, vs. 4 percent and 0 percent of Group 1 and Group 2 patients, respectively (P less than 0.05). Persistent rectal disease activity was present in 41 percent of Group 3, vs. 27 percent of Groups 1 and 2. Our study suggests that exteriorization of the closed rectal stump following subtotal colectomy is associated with fewer pelvic septic complications and minimal local morbidity, facilitates subsequent pelvic dissection, and is not associated with increased disease activity in the retained rectum.
对136例因急性溃疡性结肠炎接受结肠次全切除术患者中与保留直肠残端相关的并发症进行了回顾性研究。55例患者（第1组）将闭合的直肠残端提至皮下组织，30例患者（第2组）有开放的黏液瘘。将这些情况与51例患者（第3组）进行盆腔内Hartmann袋手术的情况进行比较。所有患者最终均接受了盆腔袋手术。所有组患者的年龄、病程、疾病活动度及术前使用类固醇情况相似。无死亡病例。第1组19例患者（35%）的直肠残端自行开放，7例（13%）发生局部左下腹伤口感染。第1组2例患者（4%）发生盆腔感染性并发症，与之相比，第2组有2例患者（7%），第3组有6例患者（12%）。第3组20%的患者随后进行盆腔解剖困难，而第1组和第2组分别为4%和0%（P<0.05）。第3组41%的患者存在持续性直肠疾病活动，而第1组和第2组为27%。我们的研究表明，结肠次全切除术后闭合直肠残端外置与较少的盆腔感染性并发症及最小的局部发病率相关，便于随后的盆腔解剖，且与保留直肠内疾病活动度增加无关。
