Zaghiyan Karen, Kamiński Jan P, Barmparas Galinos, Fleshner Phillip
Division of Colon and Rectal Surgery, Cedars-Sinai Medical Center, Los Angeles, California, USA.
Am Surg. 2016 Oct;82(10):977-981.
The risk of de novo Crohn's disease (CD) after ileal pouch-anal anastomosis (IPAA) for ulcerative colitis (UC) versus inflammatory bowel disease unclassified (IBDU) or indeterminate colitis (IC) remains debatable. Here, we present updated results after long-term follow-up of a previously studied cohort of 334 patients with UC, IBDU, or IC who underwent IPAA during a 10-year period ending 2007. Of 334 study patients, 56 per cent were male and median age was 38 years (range: 8-81). Patients were classified as UC (n = 237) or IBDU (n = 97) preoperatively and UC (n = 236) or IC (n = 98) postoperatively. After a median follow-up of 76 months (range: 3-236), 63 patients (19%) developed CD within a median of 22 months (range: 1-213) from ileostomy closure compared with the previously published 40 patients (12%) with 26-month follow-up (P = 0.01). The development of de novo CD was similar for patients undergoing IPAA for UC (n = 40; 17%), IBDU (n = 21; 22%) or those classified as having UC (n = 42; 18%) or IC (n = 19; 19%) postoperatively; P > 0.05. Thus, patients with IBDU and IC can expect equivalent long-term outcome to patients with UC after IPAA. Pouch failure occurred in 13 (4%) study patients and was equal among all four groups.
对于溃疡性结肠炎（UC）患者，与炎症性肠病未定型（IBDU）或不确定性结肠炎（IC）患者相比，回肠储袋肛管吻合术（IPAA）后发生新发克罗恩病（CD）的风险仍存在争议。在此，我们展示了对先前研究的334例UC、IBDU或IC患者队列进行长期随访后的最新结果，这些患者在截至2007年的10年期间接受了IPAA。在334例研究患者中，56%为男性，中位年龄为38岁（范围：8 - 81岁）。患者术前被分类为UC（n = 237）或IBDU（n = 97），术后被分类为UC（n = 236）或IC（n = 98）。中位随访76个月（范围：3 - 236个月）后，63例患者（19%）在回肠造口关闭后的中位时间22个月（范围：1 - 213个月）内发生了CD，相比之前发表的随访26个月时有40例患者（12%）发生CD（P = 0.01）。对于因UC接受IPAA的患者（n = 40；17%）、IBDU患者（n = 21；22%）或术后被分类为UC的患者（n = 42；18%）以及IC患者（n = 19；19%），新发CD的发生率相似；P > 0.05。因此，IBDU和IC患者在IPAA术后可预期与UC患者相当的长期结局。13例（4%）研究患者发生了储袋功能衰竭，在所有四组中发生率相同。
