Keighley M R, Winslet M C, Flinn R, Kmiot W
General Hospital, Birmingham.
Br J Surg. 1989 Jul;76(7):740-4. doi: 10.1002/bjs.1800760732.
Univariate and multivariate analyses have been used to assess the influence of 14 variables on the results of 65 consecutive ileoanal pouch procedures over 5 years. There were nine failures requiring intubation, ileostomy or pouch excision. There was a significant association between failure and pelvic sepsis (P less than 0.05, n = 8), endoanal mucosectomy (P less than 0.05, n = 7), preservation of a long rectal cuff (P less than 0.05, n = 5) and lack of experience with the operation (P less than 0.05, n = 8). Of 49 patients with preoperative evidence of ulcerative colitis, three are now known to have Crohn's disease. Functional outcome was significantly impaired in patients who developed pelvic sepsis (P less than 0.01) or a postoperative fistula (P less than 0.05), and who had an endoanal mucosectomy (P less than 0.05). Success with ileoanal pouch reconstruction increases with experience. Avoidance of sepsis is associated with a lower failure rate, improved functional results and reduced hospital stay. Preliminary colectomy is also advised to exclude Crohn's disease if the diagnosis is in question.
单因素和多因素分析已用于评估14个变量对5年间连续65例回肠储袋肛管吻合术结果的影响。有9例失败，需要插管、回肠造口术或储袋切除术。失败与盆腔感染（P<0.05，n = 8）、肛管黏膜切除术（P<0.05，n = 7）、保留长直肠袖口（P<0.05，n = 5）和缺乏手术经验（P<0.05，n = 8）之间存在显著关联。在49例术前有溃疡性结肠炎证据的患者中，现在已知有3例患有克罗恩病。发生盆腔感染（P<0.01）或术后瘘管（P<0.05）以及接受肛管黏膜切除术（P<0.05）的患者，其功能结局明显受损。回肠储袋重建的成功率随经验增加而提高。避免感染与较低的失败率、改善的功能结果和缩短的住院时间相关。如果诊断存疑，也建议进行初步结肠切除术以排除克罗恩病。
