前瞻性分析回肠炎患者回肠贮袋肛门吻合术的临床变量、血清学因素和结局。
A prospective analysis of clinical variables, serologic factors, and outcome of ileal pouch-anal anastomosis in patients with backwash ileitis.
机构信息
Division of Colon and Rectal Surgery, Cedars-Sinai Medical Center, Los Angeles, California, USA.
出版信息
Dis Colon Rectum. 2010 Jul;53(7):987-94. doi: 10.1007/DCR.0b013e3181dcb3f2.
PURPOSE
The outcome of ileal pouch-anal anastomosis in patients with backwash ileitis is controversial. We prospectively compared the outcomes of ileal pouch-anal anastomosis in colitis patients with backwash ileitis and colitis patients without backwash ileitis.
METHODS
Consecutive colitis patients undergoing ileal pouch-anal anastomosis were reviewed. All patients were classified after surgery as being either backwash ileitis-positive or backwash ileitis-negative. Serum drawn preoperatively was assayed, using enzyme-linked immunosorbent assay, for anti-Saccharomyces cerevisiae, anti-outer membrane of porin C, anti-CBir1, anti-I2, and perinuclear anti-neutrophil cytoplasmic antibody. Outcomes included acute pouchitis (antibiotic responsive), chronic pouchitis (antibiotic dependent or refractory), or de novo Crohn's disease (small inflammation above the pouch inlet or pouch fistula).
RESULTS
Out of 334 patients, 39 (12%) were backwash ileitis-positive. Compared with backwash ileitis-negative patients, backwash ileitis-positive patients had a higher incidence of pancolitis (100% vs 74%; P = .0001), primary sclerosing cholangitis (15% vs 2%; P = .001) and high-level (>100 enzyme-linked immunosorbent assay units/ml) perinuclear anti-neutrophil cytoplasmic antibody expression (29% vs 9%; P = .001). After a median follow-up of 26 months, 53 patients (16%) developed acute pouchitis, 37 (11%) developed chronic pouchitis, and 40 (12%) developed de novo Crohn's disease. There was no significant difference between the backwash ileitis-positive and backwash ileitis-negative patient groups in the incidence of acute pouchitis, chronic pouchitis, or de novo Crohn's disease.
CONCLUSION
There was a significantly higher incidence of pancolitis, primary sclerosing cholangitis, and high-level perinuclear anti-neutrophil cytoplasmic antibody expression in backwash ileitis-positive patients than in backwash ileitis-negative patients. The incidence of acute pouchitis, chronic pouchitis, and de novo Crohn's disease after ileal pouch-anal anastomosis does not differ significantly between backwash ileitis-positive and backwash ileitis-negative patients.
目的
回肠炎患者行回肠贮袋肛管吻合术的结果存在争议。我们前瞻性比较了回肠炎阳性和回肠炎阴性的结肠炎患者行回肠贮袋肛管吻合术的结果。
方法
对连续接受回肠贮袋肛管吻合术的结肠炎患者进行了回顾性分析。所有患者术后根据是否存在回肠炎分为回肠炎阳性和回肠炎阴性。术前抽取血清，采用酶联免疫吸附试验检测抗酿酒酵母抗体、外膜孔蛋白 C 抗体、CBir1 抗体、抗 I2 抗体和核周抗中性粒细胞胞质抗体。结果包括急性贮袋炎（抗生素有效）、慢性贮袋炎（抗生素依赖或难治）或新诊断的克罗恩病（贮袋入口上方或贮袋瘘口处有小范围炎症）。
结果
334 例患者中，39 例（12%）回肠炎阳性。与回肠炎阴性患者相比，回肠炎阳性患者的全结肠炎发生率更高（100% vs. 74%，P =.0001），原发性硬化性胆管炎发生率更高（15% vs. 2%，P =.001），核周抗中性粒细胞胞质抗体表达水平更高（>100 酶联免疫吸附试验单位/ml，29% vs. 9%，P =.001）。中位随访 26 个月后，53 例（16%）发生急性贮袋炎，37 例（11%）发生慢性贮袋炎，40 例（12%）发生新诊断的克罗恩病。回肠炎阳性与回肠炎阴性患者组在急性贮袋炎、慢性贮袋炎或新诊断的克罗恩病的发生率方面无显著差异。
结论
与回肠炎阴性患者相比，回肠炎阳性患者的全结肠炎、原发性硬化性胆管炎和高水平核周抗中性粒细胞胞质抗体表达的发生率更高。回肠贮袋肛管吻合术后，回肠炎阳性和回肠炎阴性患者的急性贮袋炎、慢性贮袋炎和新诊断的克罗恩病的发生率无显著差异。
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