Berki Csaba, Mohos Elemér, Réti György, Kovács Tamás, Jánó Zoltán, Mohay József, Horváth Sándor, Bognár Gábor, Bene Krisztina, Horzov Myroslav, Sándor Gábor, Tornai Gábor, Mohos Petra, Szenkovits Péter, Nagy Tibor, Orbán Csaba, Herpai Vivien, Nagy Attila
Általános és Érsebészeti Centrum, Veszprém Megyei Csolnoky Ferenc Kórház 8200 Veszprém, Kórház u. 1.
Magy Seb. 2016 Dec;69(4):159-164. doi: 10.1556/1046.69.2016.4.3.
Ulcerative colitis (CU) or Familiar Polyposis (FAP) can be the indication for proctocolectomy reconstructed with J pouch. The complete removal of the colon mucosa is essential regarding the late complications and at the same time the atraumatic surgical technique is very important concerning on the long term functional results. Both aspects seems to be answered by the stapled ileo-anal anastomosis using a "procedure for prolaps and haemorrhoids (PPH)" stapler applied by us since 2000.
117 proctocolectomies reconstructed with J pouch and ileo-anal anastomosis were performed in our department between March 1990 and September 2016 indicated by CU or by FAP. In the first time period the ileo-anal anastomosis was sutured by hand (29 cases) and since 2000 the PPH stapler was applied as a routine (88 patients). Deviating ileostomy was performed in most cases of us. The data of the 117 patients were collected from the database of our hospital, 45 of them were interviewed personally and another 31 patients were contacted by phone, so 76 patients (65%) were eligible for follow-up. Frequency of stool, use of loperamid, level of incontinence (Wexner score) and perianal dermatitis were detected. The mean follow-up time was 18.6 years in the hand-sewn anastomosis group and 7.6 years in the PPH group.
In the hand-sewn anastomosis group in 4/29 cases (13.8%) the removal of the pouch with definite ileostomy were necessary (2 pouchitis, 1 pouch necrosis, 1 recidiv rectum cancer); the mean stool frequency was 4.3 per day; the Wexner incontinence score was 8.5 and 2/15 patients (13.3%) live with ileostomy caused by incontinence. In the PPH stapled ileo-anal anastomosis group in 4/88 cases (4.5%) were the pouch removed (caused by pouchitis), the mean stool frequency was 4.0 per day; the Wexner score was 7.6 and 4/61 patients (6.6%) live with ileostomy caused by incontinence.
Based on our experience the ileo-anal anastomosis performed by PPH stapler is technically feasible, seems to be effective concerning on the complete removal of the rectal mucosa and we observed better functional results compared with the hand-sewn anastomosis. Our data should be confirmed because of the low patients' volume.
溃疡性结肠炎（UC）或家族性息肉病（FAP）可能是行J袋重建直肠结肠切除术的指征。彻底切除结肠黏膜对于预防晚期并发症至关重要，同时，无创手术技术对于长期功能结果非常重要。自2000年以来，我们使用“吻合器痔上黏膜环切术（PPH）”吻合器进行吻合器回肠肛管吻合术似乎能兼顾这两个方面。
1990年3月至2016年9月期间，我们科室对117例因UC或FAP而行J袋重建直肠结肠切除术并回肠肛管吻合术的患者进行了研究。在第一个时间段，回肠肛管吻合术采用手工缝合（29例），自2000年起常规应用PPH吻合器（88例患者）。我们大多数病例都进行了临时性回肠造口术。从我院数据库收集了117例患者的数据，其中45例接受了个人访谈，另外31例患者通过电话联系，因此76例患者（65%）符合随访条件。检测了大便频率、洛哌丁胺的使用情况、失禁程度（韦克斯纳评分）和肛周皮炎情况。手工缝合吻合术组的平均随访时间为18.6年，PPH组为7.6年。
在手工缝合吻合术组中，4/29例（13.8%）患者需要切除J袋并行永久性回肠造口术（2例袋炎、1例袋坏死、1例直肠癌复发）；平均每日大便次数为4.3次；韦克斯纳失禁评分为8.5分，2/15例患者（13.3%）因失禁行回肠造口术。在PPH吻合器回肠肛管吻合术组中，4/88例（4.5%）患者切除了J袋（因袋炎），平均每日大便次数为4.0次；韦克斯纳评分为7.6分，4/61例患者（6.6%）因失禁行回肠造口术。
根据我们的经验，PPH吻合器行回肠肛管吻合术在技术上是可行的，在彻底切除直肠黏膜方面似乎是有效的，并且与手工缝合吻合术相比，我们观察到了更好的功能结果。由于病例数较少，我们的数据有待进一步证实。
