3109例患者手工缝合与吻合器行回肠储袋肛管吻合术后的疗效比较。

Comparison of outcomes after hand-sewn versus stapled ileal pouch-anal anastomosis in 3,109 patients.

作者信息

Kirat Hasan T, Remzi Feza H, Kiran Ravi P, Fazio Victor W

机构信息

Department of Colorectal Surgery, Cleveland Clinic Foundation, Cleveland, OH 44195, USA.

出版信息

Surgery. 2009 Oct;146(4):723-9; discussion 729-30. doi: 10.1016/j.surg.2009.06.041.

DOI:10.1016/j.surg.2009.06.041

PMID:19789032

Abstract

BACKGROUND

The aim of this study was to compare outcomes after primary hand-sewn versus stapled ileal pouch-anal anastomosis (IPAA).

METHODS

Patients undergoing a primary IPAA (1983-2007) were identified from a prospective pelvic pouch database. Differences between group A (hand-sewn) and group B (stapled) for pre-operative and peri-operative factors, complications, functional outcomes, and quality of life (QOL) were investigated.

RESULTS

Of 3,382 patients with a primary IPAA, 3,109 were included. Median follow-up was 7.1 years (0.1-24). Mean age was 37.9 +/- 13.2 years. Overall, 1,741 patients (56%) were male. Group A (n = 474) and group B (n = 2635) had similar age (P = .28), sex (P = .8), albumin level (P = .74), prior colectomy (P = .98), and use of steroids (P = .1). Group A had a greater use of ileostomy (P = .001) and a longer duration of stay (P < .001). Group B had a greater body mass index (P < .001) and J-pouch (P < or = .001). Wound infection (P = .42) and pouchitis (P = .59) were similar. Anastomotic stricture (P = .002), septic complications (P = .019), bowel obstruction (P = .027), and pouch failure (P < .001) were greater in group A. At most recent follow-up, bowel frequency (P = .74) and rate of urgency were similar (P = .71). A greater proportion of patients in group A described incontinence (P < .001), seepage (P < .001), pad usage (P < .001), dietary (P < .001), social (P < .001), and work restrictions (P = .025). The Cleveland Global QOL score (P = .018) was greater in group B.

CONCLUSION

Patients undergoing a stapled IPAA had better outcomes and QOL than those undergoing a hand-sewn IPAA.

摘要

背景

本研究旨在比较原发性手工缝合与吻合器吻合回肠储袋肛管吻合术（IPAA）后的结局。

方法

从一个前瞻性盆腔储袋数据库中识别出接受原发性IPAA（1983 - 2007年）的患者。研究了A组（手工缝合）和B组（吻合器吻合）在术前和围手术期因素、并发症、功能结局及生活质量（QOL）方面的差异。

结果

在3382例接受原发性IPAA的患者中，纳入了3109例。中位随访时间为7.1年（0.1 - 24年）。平均年龄为37.9±13.2岁。总体而言，1741例患者（56%）为男性。A组（n = 474）和B组（n = 2635）在年龄（P = 0.28）、性别（P = 0.8）、白蛋白水平（P = 0.74）、既往结肠切除术（P = 0.98）及使用类固醇（P = 0.1）方面相似。A组造口术使用率更高（P = 0.001），住院时间更长（P < 0.001）。B组体重指数更高（P < 0.001），J形储袋更多（P≤0.001）。伤口感染（P = 0.42）和储袋炎（P = 0.59）相似。A组吻合口狭窄（P = 0.002）、感染性并发症（P = 0.019）、肠梗阻（P = 0.027）及储袋失败（P < 0.001）发生率更高。在最近一次随访时，排便频率（P = 0.74）和急迫率相似（P = 0.71）。A组中更多患者描述有失禁（P < 0.001）、渗漏（P < 0.001）、使用护垫（P < 0.001）、饮食（P < 0.001）、社交（P < 0.001）及工作受限情况（P = 0.025）。B组的克利夫兰全球生活质量评分更高（P = 0.018）。