Lian Lei, Fazio Victor W, Remzi Feza H, Shen Bo, Dietz David, Kiran Ravi P
Digestive Disease Institute, Cleveland Clinic, Cleveland, Ohio 44195, USA.
Dis Colon Rectum. 2009 Aug;52(8):1409-14; discussion 4414-6. doi: 10.1007/DCR.0b013e3181ab586b.
Continent ileostomy is considered an alternative for patients with a failed ileal pouch-anal anastomosis. The aim of this study is to investigate outcomes for patients undergoing continent ileostomy after a failed ileal pouch-anal anastomosis at our institution.
Patients undergoing continent ileostomy after a failed ileal pouch-anal anastomosis were identified from a prospectively maintained pouch database. Quality-of-life scores were obtained by telephone follow-up or office visit and were determined by the Cleveland Global Quality of Life Score.
Sixty-four patients were identified between 1982 and 2007. Forty-two percent were male. The median age was 36.5 (range, 14-61) years. Most common diagnoses included ulcerative colitis (n = 44, 68.8%) and Crohn's disease (n = 13, 20.3%). The indication for continent ileostomy was septic pouch complications in 56.3% patients. The previous pelvic pouch was used in 16 (25%) patients. The 30-day complication rate was 31.3%. There were no perioperative deaths. Median follow-up was five years. The long-term dysfunction rate was 50%, the complication rate was 60.9%, and the revision rate 45.3%. The median revision-free interval was 2.8 years (range, 3 months to 19 years) and the retention rate of continent ileostomy was 95.3% (61 of 64). Median continent ileostomy survival time was 4.2 (range, 1-19) years. The median quality-of-life score was 0.77.
Continent ileostomy is possible in patients wishing to avoid an external appliance after pelvic pouch failure. Despite the associated morbidity, most of this select group of highly motivated patients retain their continent ileostomy long-term and are highly satisfied with their choice of continent ileostomy.
可控性回肠造口术被认为是回肠储袋肛管吻合术失败患者的一种替代方案。本研究的目的是调查在我们机构中接受回肠储袋肛管吻合术失败后可控性回肠造口术患者的治疗结果。
从一个前瞻性维护的储袋数据库中识别出接受回肠储袋肛管吻合术失败后可控性回肠造口术的患者。通过电话随访或门诊就诊获得生活质量评分，并由克利夫兰全球生活质量评分确定。
在1982年至2007年期间识别出64例患者。42%为男性。中位年龄为36.5岁（范围14 - 61岁）。最常见的诊断包括溃疡性结肠炎（n = 44，68.8%）和克罗恩病（n = 13，20.3%）。56.3%的患者进行可控性回肠造口术的指征是储袋感染并发症。16例（25%）患者使用了先前的盆腔储袋。30天并发症发生率为31.3%。无围手术期死亡。中位随访时间为5年。长期功能障碍发生率为50%，并发症发生率为60.9%，翻修率为45.3%。中位无翻修间隔时间为2.8年（范围3个月至19年），可控性回肠造口术的保留率为95.3%（64例中的61例）。可控性回肠造口术的中位生存时间为4.2年（范围1 - 19年）。中位生活质量评分为0.77。
对于盆腔储袋失败后希望避免使用外置装置的患者，可控性回肠造口术是可行的。尽管存在相关的发病率，但这一特定群体中大多数积极性高的患者长期保留其可控性回肠造口术，并对其选择的可控性回肠造口术非常满意。
