Ryoo Seung-Bum, Oh Heung-Kwon, Han Eon Chul, Ha Heon-Kyun, Moon Sang Hui, Choe Eun Kyung, Park Kyu Joo
Seung-Bum Ryoo, Heung-Kwon Oh, Eon Chul Han, Heon-Kyun Ha, Sang Hui Moon, Eun Kyung Choe, Kyu Joo Park, Division of Colorectal Surgery, Department of Surgery, Seoul National University College of Medicine, Seoul 110-744, South Korea.
World J Gastroenterol. 2014 Jun 21;20(23):7488-96. doi: 10.3748/wjg.v20.i23.7488.
To investigate the outcomes of treatments for complications after ileal pouch-anal anastomosis (IPAA) in Korean patients with ulcerative colitis.
Between March 1998 and February 2013, 72 patients (28 male and 44 female, median age 43.0 years ± 14.0 years) underwent total proctocolectomy with IPAA. The study cohort was registered prospectively and analyzed retrospectively. Patient characteristics, medical management histories, operative findings, pathology reports and postoperative clinical courses, including early postoperative and late complications and their treatments, were reviewed from a medical record system. All of the ileal pouches were J-pouch and were performed with either the double-stapling technique (n = 69) or a hand-sewn (n = 3) technique.
Thirty-one (43.1%) patients had early complications, with 12 (16.7%) patients with complications related to the pouch. Pouch bleeding, pelvic abscesses and anastomosis ruptures were managed conservatively. Patients with pelvic abscesses were treated with surgical drainage. Twenty-seven (38.0%) patients had late complications during the follow-up period (82.5 ± 50.8 mo), with 21 (29.6%) patients with complications related to the pouch. Treatment for pouchitis included antibiotics or anti-inflammatory drugs. Pouch-vaginal fistulas, perianal abscesses or fistulas and anastomosis strictures were treated surgically. Pouch failure developed in two patients (2.8%). Analyses showed that an emergency operation was a significant risk factor for early pouch-related complications compared to elective procedures (55.6% vs 11.1%, P < 0.05). Pouchitis was related to early (35.3%) and the other late pouch-related complications (41.2%) (P < 0.05). The complications did not have an effect on pouch failure nor pouch function.
The complications following IPAA can be treated successfully. Favorable long-term outcomes were achieved with a lower pouch failure rate than reported in Western patients.
探讨韩国溃疡性结肠炎患者回肠储袋肛管吻合术（IPAA）后并发症的治疗结果。
1998年3月至2013年2月期间，72例患者（男28例，女44例，中位年龄43.0岁±14.0岁）接受了全直肠结肠切除术并进行IPAA。该研究队列进行前瞻性登记并回顾性分析。从病历系统中查阅患者特征、医疗管理史、手术发现、病理报告及术后临床病程，包括术后早期和晚期并发症及其治疗情况。所有回肠储袋均为J形储袋，采用双吻合器技术（n = 69）或手工缝合技术（n = 3）进行手术。
31例（43.1%）患者出现早期并发症，其中12例（16.7%）患者的并发症与储袋有关。储袋出血、盆腔脓肿和吻合口破裂采用保守治疗。盆腔脓肿患者接受手术引流治疗。27例（38.0%）患者在随访期间（82.5±50.8个月）出现晚期并发症，其中21例（29.6%）患者的并发症与储袋有关。储袋炎的治疗包括使用抗生素或抗炎药物。储袋阴道瘘、肛周脓肿或肛瘘以及吻合口狭窄采用手术治疗。2例患者（2.8%）出现储袋功能丧失。分析表明，与择期手术相比，急诊手术是早期储袋相关并发症的显著危险因素（55.6%对11.1%，P<0.05）。储袋炎与早期（35.3%）及其他晚期储袋相关并发症（41.2%）有关（P<0.05）。这些并发症对储袋功能丧失和储袋功能均无影响。
IPAA术后并发症可成功治疗。长期预后良好，储袋功能丧失率低于西方患者报道。
