Löfberg R, Leijonmarck C E, Broström O, Hellers G, Tribukait B, Ost A
Department of Medicine and Surgery, Huddinge Hospital, Stockholm, Sweden.
Dis Colon Rectum. 1991 Jul;34(7):566-71. doi: 10.1007/BF02049896.
In a follow-up study of an epidemiologically defined patient group comprising 1,274 patients with ulcerative colitis diagnosed in Stockholm County during 1955-1979, 55 patients had undergone colectomy with ileorectal anastomosis (IRA). Nine of these were found to have Crohn's disease after histopathologic review of the colectomy specimens. Of the 46 patients with ulcerative colitis remaining for evaluation, two died postoperatively. Twenty-five patients were subsequently reoperated with rectal excision owing to intractable inflammatory activity (n = 22, one postoperative death) or owing to dysplasia (n = 3). Of 19 patients with their IRA still intact at time of follow-up, 15 patients (median disease duration 23 years) had a flexible sigmoidoscopy with multiple biopsies performed. The average length of the remaining rectum and sigmoid colon was 26 cm. No patient had findings of dysplasia, carcinoma, or DNA aneuploidy. None of the four remaining patients had developed dysplasia or carcinoma at the time of the latest regular rigid sigmoidoscopy. The risk of malignant transformation in this selected group of patients with ulcerative colitis operated upon with colectomy and IRA derived from an epidemiologically defined population seems to be low.
在一项针对一个流行病学定义的患者群体的随访研究中，该群体由1955年至1979年期间在斯德哥尔摩县诊断出的1274例溃疡性结肠炎患者组成，其中55例患者接受了结肠切除术并进行回肠直肠吻合术（IRA）。在对结肠切除标本进行组织病理学检查后，发现其中9例患有克罗恩病。在剩下的46例接受评估的溃疡性结肠炎患者中，2例术后死亡。随后，25例患者因难治性炎症活动（n = 22，1例术后死亡）或发育异常（n = 3）而再次接受直肠切除术。在随访时IRA仍完好的19例患者中，15例患者（疾病中位病程23年）接受了乙状结肠镜检查并进行了多次活检。剩余直肠和乙状结肠的平均长度为26厘米。没有患者有发育异常、癌或DNA非整倍体的发现。在最近一次定期硬式乙状结肠镜检查时，其余4例患者均未发生发育异常或癌。在这个从流行病学定义的人群中接受结肠切除术和IRA手术的特定溃疡性结肠炎患者组中，恶性转化的风险似乎较低。
