Schneider Ralph, Schneider Claudia, Dalchow Anne, Jakobeit Christian, Möslein Gabriela
Department of General and Visceral Surgery, Coloproctology, HELIOS St. Josefs-Hospital, Axstrasse 35, 44879, Bochum-Linden, Germany,
Int J Colorectal Dis. 2015 Aug;30(8):1109-15. doi: 10.1007/s00384-015-2223-9. Epub 2015 May 3.
Prophylactic proctocolectomy with an ileoanal neo-reservoir is the established procedure in non-attenuated familial adenomatous polyposis (FAP). Traditionally, the ileal J-pouch is created by doubling 15 cm of the terminal ileum. Pouch inlet problems are not infrequently encountered in longer pouches. On this rationale, this series reports on the functional outcome and quality of life (QoL) following standardized construction of a shorter J-pouch with a limb of 8-9 cm length.
All patients of a single-surgeon series with FAP who underwent hand-assisted laparoscopic proctocolectomy and small ileal pouch-anal anastomosis as the primary procedure between 10/2005 and 04/2010 and responded to the questionnaire were included and retrospectively analyzed.
A total of 46 patients (78 %) out of the consecutive series who underwent operation in this period were included in the study. After a mean follow-up of 38 months, 40/46 patients (87 %) did not report any incontinence and 3 patients (6.5 %) complained about occasional nocturnal incontinence (3 failed to answer this question). The mean stool frequency per 24 h was 6.25. No significant difference was encountered between the QoL outcome of our patients versus the German normative population. Comparable results were achieved in a study analyzing the long-term results in FAP patients with a 15-cm pouch.
Smaller, 8-9 cm J-pouches show excellent functional results both in short- and in long-term results. The hand-assisted procedure was safe and no conversions were required. QoL is equal to a normative population, as it is in a series of patients with larger J-pouches.
采用回肠肛管新储袋的预防性直肠结肠切除术是治疗非弱化型家族性腺瘤性息肉病（FAP）的既定手术方式。传统上，回肠J形储袋是通过将15厘米末段回肠对折形成。在较长的储袋中，储袋入口问题并不少见。基于这一理论依据，本系列报告了标准化构建长度为8 - 9厘米肠段的较短J形储袋后的功能结局和生活质量（QoL）。
纳入并回顾性分析了2005年10月至2010年4月间由同一外科医生主刀、接受手辅助腹腔镜直肠结肠切除术及小肠储袋肛管吻合术作为主要手术且对问卷作出回应的FAP单一系列患者。
在此期间接受手术的连续系列患者中，共有46例（78%）纳入本研究。平均随访38个月后，40/46例患者（87%）未报告任何失禁情况，3例患者（6.5%）抱怨偶尔有夜间失禁（3例未回答此问题）。每24小时的平均排便频率为6.25次。我们患者的生活质量结局与德国正常人群之间未发现显著差异。在一项分析15厘米储袋FAP患者长期结果的研究中也取得了类似结果。
8 - 9厘米的较小J形储袋在短期和长期结果中均显示出优异的功能效果。手辅助手术安全，无需中转。生活质量与正常人群相当，与一系列较大J形储袋患者的情况相同。
