Sanford R. Weiss, MD Center for Hereditary Colorectal Neoplasia, Department of Colorectal Surgery, Digestive Diseases Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA.
Dis Colon Rectum. 2011 Nov;54(11):1388-91. doi: 10.1097/DCR.0b013e31822f8d91.
Nobody has analyzed the sequelae of desmoids according to the type of surgery that precipitated them.
This study aims to determine whether the clinical effects of abdominal desmoids would be worse in patients with restorative proctocolectomy than in patients with ileorectal anastomosis.
This is a retrospective, database study.
Included were patients with familial adenomatous polyposis who had undergone proctocolectomy with IPAA or colectomy and ileorectal anastomosis, and subsequently developed an intra-abdominal desmoid tumor.
The primary outcome measures were the clinical course of the desmoids; morbidity, and the requirement for stoma.
There were 86 patients: 49 had restorative proctocolectomy and 37 had ileorectal anastomosis. Patient demographics were similar. Average follow-up was 9.8 years (range, 2.7-23.8) and 16.3 years (range, 2.3 - 42.9). Treatment of the desmoids included surgery (64.4% vs 65.6%), medical therapy (69.4% vs 59.5%), chemotherapy (36.2% vs 30.0%), and radiotherapy (4.5% vs 10.0%), and was the same for each group. The overall complication rate of desmoids was similar, approaching 70%. The risk of individual complications was also similar (bleeding (2.0% vs 0.0%), fistula (10.2% vs 13.5%), bowel obstruction (32.7% vs 48.6%), pain (34.7% vs 21.6%), and death related to desmoid tumors (2.0% vs 10.8%)); 38.8% of the restorative proctocolectomy group and 51.4% the ileorectal group had surgery for desmoid tumor complications (P = .21), and 22.4% and 22.2% of patients ultimately had permanent stomas.
This study was limited by the relatively small numbers of patients.
The morbidity associated with desmoid tumors has not been shown to differ, whether they arise after restorative proctocolectomy or ileorectal anastomosis.
目前尚无研究根据导致其发生的手术类型对腹外型纤维瘤病的后遗症进行分析。
本研究旨在确定在接受直肠结肠切除术+回肠贮袋肛管吻合术（IPAA）或结直肠切除术+回肠直肠吻合术的患者中，发生腹内纤维瘤病时，哪种手术的临床效果更差。
这是一项回顾性数据库研究。
纳入标准为家族性腺瘤性息肉病患者，这些患者接受直肠结肠切除术+IPAA 或结直肠切除术+回肠直肠吻合术，随后发生腹内纤维瘤肿瘤。
主要观察指标为纤维瘤病的临床病程、发病率和造口需求。
共纳入 86 例患者：49 例行直肠结肠切除术+IPAA，37 例行结直肠切除术+回肠直肠吻合术。患者的人口统计学特征相似。平均随访时间为 9.8 年（范围，2.7-23.8 年）和 16.3 年（范围，2.3-42.9 年）。纤维瘤病的治疗包括手术（64.4%比 65.6%）、药物治疗（69.4%比 59.5%）、化疗（36.2%比 30.0%）和放疗（4.5%比 10.0%），每组治疗方法相同。纤维瘤病的总体并发症发生率相似，接近 70%。每种并发症的风险也相似（出血（2.0%比 0.0%）、瘘管（10.2%比 13.5%）、肠梗阻（32.7%比 48.6%）、疼痛（34.7%比 21.6%）和与纤维瘤瘤相关的死亡（2.0%比 10.8%））；直肠结肠切除术+IPAA 组中有 38.8%和回肠直肠吻合术组中有 51.4%的患者因纤维瘤病并发症而行手术治疗（P =.21），22.4%和 22.2%的患者最终行永久性造口术。
本研究的患者数量相对较少，存在一定局限性。
无论发生在直肠结肠切除术+IPAA 后还是回肠直肠吻合术后，腹外型纤维瘤病的发病率与手术相关的发病率均无差异。
