Digestive Disease Institute, the Cleveland Clinic Foundation, Cleveland, OH 44195, USA.
Aliment Pharmacol Ther. 2010 Apr;31(7):745-53. doi: 10.1111/j.1365-2036.2009.04227.x. Epub 2009 Dec 25.
Crohn's disease is generally considered a relative contraindication for restorative proctocolectomy with ileal pouch anastomosis (IPAA). The natural history of IPAA in these patients has not well been defined.
To evaluate the natural history of IPAA in patients with a well-defined preoperative Crohn's disease.
All patients from the Pouchitis Clinic who had a preoperative diagnosis of Crohn's disease were screened and 11 patients met the inclusion criteria. The control group (with a 1:4 ratio) consisted of IPAA patients with a preoperative diagnosis of UC.
During the follow-up period of 5.0 years, 7 of 11 (63.6%) with a preoperative diagnosis of Crohn's disease developed Crohn's disease of the pouch. Crohn's disease of the pouch developed 0.2-15 years after ileostomy closure. The remaining four patients with a preoperative diagnosis of Crohn's disease did not demonstrate signs of Crohn's disease in 2, 11, 11 and 24 years after pouch surgery, respectively.
Post-operative development of Crohn's disease of the pouch was common in patients with a preoperative diagnosis of Crohn's disease who underwent IPAA. Long-term medical therapy was often required. Large multi-centre studies are warranted to delineate further the natural history of the disease, before Crohn's disease is considered an indication for IPAA.
一般认为，对于患有克罗恩病的患者，进行回肠储袋肛管吻合术（IPAA）是相对禁忌证。这些患者的 IPAA 自然病史尚未得到很好的定义。
评估术前明确诊断为克罗恩病的患者的 IPAA 自然病史。
从储袋炎诊所筛选出所有术前诊断为克罗恩病的患者，并纳入 11 名符合条件的患者。对照组（1:4 比例）由术前诊断为 UC 的 IPAA 患者组成。
在 5.0 年的随访期间，11 名术前诊断为克罗恩病的患者中有 7 名（63.6%）发生了储袋克罗恩病。储袋克罗恩病在肠造口关闭后 0.2-15 年内发生。另外 4 名术前诊断为克罗恩病的患者，分别在 pouch 手术后 2、11、11 和 24 年时没有出现克罗恩病的迹象。
术前诊断为克罗恩病的患者在接受 IPAA 后，储袋克罗恩病的发展较为常见，通常需要长期的药物治疗。有必要进行大型多中心研究，进一步阐明疾病的自然病史，以便在考虑将克罗恩病作为 IPAA 的适应证之前。
