Ishii Hiroaki, Kawai Kazushige, Hata Keisuke, Shuno Yasutaka, Nishikawa Takeshi, Tanaka Toshiaki, Tanaka Junichiro, Kiyomatsu Tomomichi, Nozawa Hiroaki, Kazama Shinsuke, Yamaguchi Hironori, Ishihara Soichiro, Sunami Eiji, Kitayama Joji, Watanabe Toshiaki
1 Department of Surgical Oncology, Faculty of Medicine, the University of Tokyo, Tokyo, Japan.
2 Department of Surgery, Chigasaki Municipal Hospital, Tokyo, Japan.
Int Surg. 2015 Jul;100(7-8):1169-76. doi: 10.9738/INTSURG-D-15-00012.1.
Total proctocolectomy with ileal pouch-anal anastomosis (IPAA) is the standard surgical treatment for patients with ulcerative colitis (UC). The purpose of this study was to investigate the long-term functional outcomes and quality of life (QOL) associated with hand-sewn and stapled IPAA. Ninety-one patients with UC had undergone IPAA using hand-sewn anastomosis with mucosectomy (32 patients) or stapled anastomosis (59 patients) from January 1988 to May 2010. Patients were evaluated according to patient characteristics, postoperative complications, functional outcomes and QOL. The QOL of patients were evaluated using the Medical Outcomes Study Short Form 36 (SF-36) and the Inflammatory Bowel Disease Questionnaire (IBDQ). Numbers of patients with colorectal cancer or dysplasia were significantly greater in the hand-sewn IPAA group (P < 0.01). These patients had longer disease durations and were older (both P < 0.01). There was no difference in the incidence of complications between the groups, except for a greater incidence of postoperative anal fistula in the stapled group (P = 0.03). In the early postsurgery period, both the frequency of bowel movements and the rate of soiling were significantly higher in the hand-sewn group, but in a later period, there was no difference in these events >3 years after surgery. The SF-36 and IBDQ results were similar in the two groups, indicating that hand-sewn and stapled IPAA result in similar QOL in the late postoperative period. Postoperative complications, functional outcomes, and long-term QOL were similar in patients who had received hand-sewn or stapled IPAA.
全结直肠切除回肠储袋肛管吻合术（IPAA）是溃疡性结肠炎（UC）患者的标准外科治疗方法。本研究的目的是调查手工缝合和吻合器辅助的IPAA的长期功能结局和生活质量（QOL）。1988年1月至2010年5月，91例UC患者接受了IPAA手术，其中32例采用手工缝合吻合术加黏膜切除术，59例采用吻合器辅助吻合术。根据患者特征、术后并发症、功能结局和QOL对患者进行评估。使用医学结局研究简明健康调查问卷（SF-36）和炎症性肠病问卷（IBDQ）评估患者的QOL。手工缝合IPAA组结直肠癌或发育异常患者的数量显著更多（P<0.01）。这些患者的病程更长且年龄更大（均P<0.01）。两组之间并发症的发生率没有差异，但吻合器辅助组术后肛瘘的发生率更高（P=0.03）。在术后早期，手工缝合组的排便频率和污粪率均显著更高，但在后期，术后3年以上这些情况没有差异。两组的SF-36和IBDQ结果相似，表明手工缝合和吻合器辅助的IPAA在术后晚期导致相似的QOL。接受手工缝合或吻合器辅助IPAA的患者术后并发症、功能结局和长期QOL相似。
