Polyposis Registry and Department of Surgery, St Mark’s Hospital, London, United Kingdom.
Ann Surg. 2011 Feb;253(2):314-7. doi: 10.1097/SLA.0b013e318f3f498.
The study compared the risk of adenoma or carcinoma formation in the anorectal segment after either mucosectomy with manual anastomosis or stapled ileoanal anastomosis (IAA) following restorative proctocolectomy (RPC) for familial adenomatous polyposis (FAP).
Few data exist on the risk of adenoma formation after either technique in FAP.
All endoscopy and histology reports for patients having RPC for FAP attending for annual pouchoscopy from 1978 to 2007 were reviewed. The incidence, timing, and histological characteristics of adenoma or carcinoma formation were recorded.
Of the 206 patients, 140 attended for endoscopic follow-up for a median of 10.3 years after RPC. Fifty-two patients developed neoplastic transformation in the anorectal segment, with a cumulative risk at 10 years of 22.6% after mucosectomy with manual anastomosis and 51.1% after stapled IAA (P < 0.001). The median time to first adenoma was longer after mucosectomy with handsewn anastomosis than after stapled IAA (10.1 vs 6.5 years, P < 0.001). On multivariate analysis, stapled IAA (hazard ratio= 3.45, 95% confidence interval = 1.01–4.98) and age at RPC older than 40 years (hazard ratio = 2.20, 95% confidence interval = 1.01–4.89) were significantly associated with increased risk of adenoma formation. Nine patients developed a large (>10 mm) adenoma. One patient (handsewn ileoanal anastomosis) developed adenocarcinoma in the anorectal mucosa at 13 years and required pouch excision.
Adenoma formation in the anorectal mucosa after RPC for FAP is common but carcinoma is rare. The risk is lower after mucosectomy with handsewn anastomosis than after stapled IAA. Regular endoscopic surveillance after either technique is mandatory.
本研究比较了经直肠黏膜切除吻合术（手工吻合）或吻合器直肠黏膜环切钉合术（stapled ileoanal anastomosis，IAA）行回肠贮袋肛管吻合术（restorative proctocolectomy，RPC）治疗家族性腺瘤性息肉病（familial adenomatous polyposis，FAP）后，在肛直肠段发生腺瘤或癌的风险。
在 FAP 中，这两种技术后发生腺瘤形成的风险数据很少。
回顾 1978 年至 2007 年期间，因 FAP 行 RPC 后每年接受储袋内镜检查的患者的所有内镜和组织学报告。记录腺瘤或癌的发生、时间和组织学特征。
206 例患者中，140 例患者在 RPC 后中位随访 10.3 年接受内镜随访。52 例患者在肛直肠段发生肿瘤转化，10 年累积风险为经直肠黏膜切除吻合术为 22.6%，吻合器直肠黏膜环切钉合术为 51.1%（P < 0.001）。经直肠黏膜切除吻合术的首次腺瘤时间长于吻合器直肠黏膜环切钉合术（10.1 年比 6.5 年，P < 0.001）。多变量分析显示，吻合器直肠黏膜环切钉合术（风险比=3.45，95%置信区间=1.01–4.98）和 RPC 时年龄大于 40 岁（风险比=2.20，95%置信区间=1.01–4.89）与腺瘤形成风险增加显著相关。9 例患者发生>10mm 的大腺瘤。1 例（吻合器直肠黏膜环切钉合术）在 13 年时直肠肛管黏膜发生腺癌，需要切除储袋。
FAP 行 RPC 后，肛直肠黏膜发生腺瘤是常见的，但癌罕见。经直肠黏膜切除吻合术的风险低于吻合器直肠黏膜环切钉合术。两种技术后均需要定期内镜监测。
