Seetharamaiah Rupa, West Brady T, Ignash Sarah J, Pakarinen Mikko P, Koivusalo Antti, Rintala Risto J, Liu Donald C, Spencer Ariel U, Skipton Kathleen, Geiger James D, Hirschl Ronald B, Coran Arnold G, Teitelbaum Daniel H
Section of Pediatric Surgery, C S Mott Children's Hospital, University of Michigan Health System, Ann Arbor, MI 48109, USA.
J Pediatr Surg. 2009 Jul;44(7):1410-7. doi: 10.1016/j.jpedsurg.2009.01.006.
Outcomes remain controversial for patients undergoing straight (SIAA) vs J pouch (JPAA) ileoanal anastomosis, particularly in children where fewer such cases are performed. Our 3 centers have had extensive experience with both techniques. Thus, we had the unique opportunity to compare outcomes within the same centers.
We retrospectively analyzed 250 children after proctocolectomy with either SIAA or JPAA, for the first 3 years after pull-through. A functional stooling score was developed to further assess outcomes. Data were analyzed using chi(2) tests and generalized linear mixed models for repeated measures.
Two hundred three patients had sufficient data for complete analysis (42% males; mean surgery age, 15 +/- 7years). Surgical indications were ulcerative colitis (168) and familial adenomatoid polyposis (35). Surgical procedures included SIAA (112) and JPAA (91). Daytime and nighttime stooling frequencies were significantly higher (P < .013) for SIAA patients at 1 to 24 months after pull-through; however, stooling frequencies began approximating each other by this time. Symptomatic pouchitis (compared to enteritis after SIAA) was significantly higher in JPAA patients (odds ratio, 4.5; confidence interval, 2.32-8.72). Frequency of pouchitis declined with time. There was no significant difference in the incidence of surgical complications between the 2 groups. Finally, continence rates were strikingly good in both groups compared to previously reported series.
Straight ileoanal anastomosis and JPAA are associated with considerable morbidity; SIAA has higher stool frequency and JPAA has increased pouchitis. Over time, we found that problems improved, and functional stooling scores became similar. JPAA had consistently lower stool frequency and better continence rates; however, these differences were small and may have minimal clinical significance. In addition, such differences need to be balanced against the high rate of pouchitis with JPAA. Continence was excellent regardless of the technique.
对于接受直型回肠肛管吻合术（SIAA）与J袋回肠肛管吻合术（JPAA）的患者，其手术结果仍存在争议，尤其是在儿童中，此类手术的实施例数较少。我们这3个中心在这两种技术方面都有丰富的经验。因此，我们有独特的机会在同一中心内比较手术结果。
我们回顾性分析了250例接受直肠结肠切除术后行SIAA或JPAA的儿童，观察其术后3年的情况。制定了功能性排便评分以进一步评估手术结果。使用卡方检验和广义线性混合模型对重复测量数据进行分析。
203例患者有足够的数据进行完整分析（42%为男性；平均手术年龄15±7岁）。手术指征为溃疡性结肠炎（168例）和家族性腺瘤性息肉病（35例）。手术方式包括SIAA（112例）和JPAA（91例）。在术后1至24个月，SIAA患者的白天和夜间排便频率显著更高（P<.013）；然而，到此时排便频率开始相互接近。JPAA患者的症状性袋炎（与SIAA后的肠炎相比）显著更高（优势比，4.5；置信区间，2.32 - 8.72）。袋炎的发生率随时间下降。两组手术并发症的发生率无显著差异。最后，与先前报道的系列相比，两组的控便率都非常好。
直型回肠肛管吻合术和JPAA都伴有相当高的发病率；SIAA的排便频率更高，JPAA的袋炎发生率更高。随着时间推移，我们发现问题有所改善，功能性排便评分变得相似。JPAA的排便频率一直较低且控便率更好；然而，这些差异很小，可能具有极小的临床意义。此外这些差异需要与JPAA较高的袋炎发生率相权衡。无论采用何种技术，控便情况都非常好。
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