Lohmuller J L, Pemberton J H, Dozois R R, Ilstrup D, van Heerden J
Department of Surgery, Mayo Medical School, Mayo Clinic, Rochester, MN 55905.
Ann Surg. 1990 May;211(5):622-7; discussion 627-9.
Although the etiology of pouchitis after ileal pouch-anal anastomosis (IPAA) is unknown, its manifestations resemble those of nonspecific inflammatory bowel disease, including, anecdotally, the apparent ability to evoke extraintestinal manifestations (EIM) of inflammatory bowel disease (IBD). Our aim was to determine in what manner pouchitis and EIMs were associated. The computerized records of 819 consecutive patients who underwent IPAA between January 1981 and December 1988 were reviewed. Eighty-five patients were excluded (because of incomplete follow-up, death, or permanent ileostomy). Follow-up of the remaining 734 patients was complete (mean, 41 months). The mean age was 32 years and the ratio of men to women was 1:1. Ileal pouch-anal anastomosis was performed for chronic ulcerative colitis in 91% of patients and for familial adenomatous polyposis in 9%. Pouchitis occurred in 31% of chronic ulcerative colitis patients and 6% of familial adenomatous polyposis patients (p less than 0.01). The mean time to first occurrence was 17 months. Pouchitis recurred in 61% of patients at risk. Patients with preoperative and postoperative EIMs had significantly higher rates of pouchitis than did patients without EIMs (39% preoperative EIMs versus 26% with no EIMs, p less than 0.001; 53% postoperative EIMs versus 25% with no EIMs, p less than 0.001). Of patients with pouchitis in whom EIMs resolved after IPAA but then recurred (n = 12), EIMs recurred when pouchitis occurred and abated when pouchitis was treated in seven patients. We concluded that pouchitis occurred frequently after IPAA and that patients with EIMs were at higher risk of developing pouchitis than were patients who never had EIMs. Furthermore some patients experienced a temporal relationship between flares of EIMs and pouchitis. These results imply that pouchitis may be a novel manifestation of inflammatory bowel disease persisting after operation.
尽管回肠储袋肛管吻合术（IPAA）后袋炎的病因尚不清楚，但其表现与非特异性炎症性肠病相似，据传闻，它似乎有引发炎症性肠病（IBD）肠外表现（EIM）的能力。我们的目的是确定袋炎与EIMs是以何种方式相关联的。回顾了1981年1月至1988年12月期间连续接受IPAA的819例患者的计算机化记录。85例患者被排除（因随访不完整、死亡或永久性回肠造口术）。其余734例患者的随访完整（平均41个月）。平均年龄为32岁，男女比例为1:1。91%的患者因慢性溃疡性结肠炎行回肠储袋肛管吻合术，9%因家族性腺瘤性息肉病行该手术。慢性溃疡性结肠炎患者中31%发生袋炎，家族性腺瘤性息肉病患者中6%发生袋炎（p<0.01）。首次发生的平均时间为17个月。有风险的患者中61%袋炎复发。术前和术后有EIMs的患者袋炎发生率明显高于无EIMs的患者（术前有EIMs的患者为39%，无EIMs的患者为26%，p<0.001；术后有EIMs的患者为53%，无EIMs的患者为25%，p<0.001）。在IPAA后EIMs缓解但随后复发的袋炎患者中（n = 12），7例患者EIMs在袋炎发生时复发，在袋炎治疗时缓解。我们得出结论，IPAA后袋炎频繁发生，有EIMs的患者比从未有过EIMs的患者发生袋炎的风险更高。此外，一些患者在EIMs发作和袋炎之间存在时间关系。这些结果表明，袋炎可能是术后持续存在的炎症性肠病的一种新表现。
