Department of General, Gastroenterological and Endocrinological Surgery, Poznan University of Medical Sciences, Poznań, Poland.
Colorectal Dis. 2012 Jan;14(1):92-7. doi: 10.1111/j.1463-1318.2011.02547.x.
Dysplasia of the pouch mucosa after restorative proctocolectomy is rare. The aim of this study was to establish whether there is a correlation between pouchitis and dysplasia.
A group of 276 patients treated for ulcerative colitis by restorative proctocolectomy between 1984 and 2009 was analysed. The presence or absence of pouchitis and dysplasia within the pouch was evaluated.
Inflammation was diagnosed in 66 (23.9%) patients, low-grade dysplasia in five (1.8%), high-grade dysplasia in three (1.1%), and cancer in one patient (0.4%). The prevalence of low-grade dysplasia was significantly higher in patients with inflammation than in those without (P < 0.04). High-grade dysplasia was significantly more frequent in pouchitis than in non-inflamed pouches (P < 0.01). Logistic regression analysis suggested that the occurrence of mucosal inflammation increased the risk of low grade dysplasia.
Patients with chronic pouchitis are at risk of dysplasia and require surveillance of the pouch.
直肠结肠切除术后吻合口黏膜发育不良较为罕见。本研究旨在明确 pouchitis 与发育不良之间是否存在相关性。
分析了 1984 年至 2009 年间接受直肠结肠切除术治疗溃疡性结肠炎的 276 例患者。评估了患者的 pouch 内是否存在 pouchitis 和发育不良。
66 例（23.9%）患者存在炎症，5 例（1.8%）存在低级别异型增生，3 例（1.1%）存在高级别异型增生，1 例（0.4%）存在癌症。存在炎症的患者中低级别异型增生的发生率明显高于无炎症的患者（P < 0.04）。 pouchitis 患者中高级别异型增生的发生率明显高于无炎症的 pouch（P < 0.01）。逻辑回归分析表明，黏膜炎症的发生增加了低级别异型增生的风险。
慢性 pouchitis 患者存在发育不良的风险，需要对 pouch 进行监测。
