Telander R L, Spencer M, Perrault J, Telander D, Zinsmeister A R
Department of Surgery, Fargo Clinic/St. Luke's Children's Hospital MeritCare, N.D. 58123.
Surgery. 1990 Oct;108(4):717-23; discussion 723-5.
The purpose of this study was to carry out a long-term study of the ileoanal anastomosis (IAA) in children and young adults, comparing the straight IAA to the J pouch. One hundred twenty-one young people who had undergone IAA were studied, with 114 available for long-term follow-up. One hundred one were 18 years and under. Forty-nine patients had a straight IAA and 72 had a J-pouch reservoir. There were no deaths. After surgery, three children had intraabdominal sepsis and one had pelvic sepsis, but it did not lead to excision of the IAA. The mean stool frequency in all 114 patients was 5.0 +/- 2.5 per day and 1.2 +/- 1.1 at night. The mean number of stools for the straight IAA was 6 per day and 2.1 at night. The mean number of stools for the straight IAA with balloon dilations was 5.8 per day and 1.2 at night, and for the J pouch it was 4 per day and 1 at night. Patients with both the J pouch and straight IAA had good to excellent sensation, with patients with the J pouch always able to distinguish flatus from stool in 87% of patients and almost always in 13%. Daytime continence was very good in both groups. Moderate nighttime loss of stool occurred in 10 patients, 6 with a straight IAA and 4 with a J pouch. Ninety-five percent of the 114 patients were satisfied or very satisfied, with most children with a J pouch very satisfied. The J pouch remains the procedure of choice in young people.
本研究的目的是对儿童和青年进行回肠肛管吻合术（IAA）的长期研究，比较直型IAA和J袋。对121例接受IAA手术的年轻人进行了研究，其中114例可进行长期随访。101例年龄在18岁及以下。49例患者接受直型IAA，72例患者接受J袋贮袋术。无死亡病例。术后，3例儿童发生腹腔内感染，1例发生盆腔感染，但未导致IAA切除。114例患者的平均每日排便次数为5.0±2.5次，夜间为1.2±1.1次。直型IAA患者的平均每日排便次数为6次，夜间为2.1次。接受球囊扩张的直型IAA患者平均每日排便次数为5.8次，夜间为1.2次，J袋患者平均每日排便次数为4次，夜间为1次。J袋和直型IAA患者的感觉良好至极佳，87%的J袋患者总能区分屁和粪便，13%的患者几乎总能区分。两组患者白天的控便能力都很好。10例患者夜间有中度大便失禁，6例为直型IAA，4例为J袋。114例患者中有95%满意或非常满意，大多数J袋儿童非常满意。J袋仍然是年轻人的首选手术方式。
