Kroesen A J
Allgemein- und Viszeralchirurgie, Krankenhaus Porz am Rhein, Urbacher Weg 19, 51149, Köln, Deutschland.
Chirurg. 2017 Jul;88(7):574-581. doi: 10.1007/s00104-017-0444-x.
Restorative proctocolectomy under formation of an ileoanal/ileorectal J‑pouch has become the procedure of choice in the therapy of ulcerative colitis. Although patients experience a dramatic improvement of their quality of life, surgery is not successful in about 5-10% of all treated patients. The reasons for failure are chronic pouchitis, incontinence, delayed diagnosis of Crohn's disease, fistula, surgical complications, too long remnant rectal stump, chronic abscess, and surgical technical errors. Some of the reasons do not always prevent the loss of a well-functioning ileoanal pouch. In many cases, correction, closure of fistulas or even a complete reconstruction of the ileoanal pouch are possible. Based on a review of the literature and our own experience, we show in 887 patients a success rate of 75% with acceptable pouch function. Indications, technics, and results are presented.
在回肠肛管/回肠直肠J形贮袋形成下进行的修复性直肠结肠切除术已成为溃疡性结肠炎治疗的首选手术方式。尽管患者的生活质量有显著改善，但在所有接受治疗的患者中，约5% - 10%的手术并不成功。失败的原因包括慢性贮袋炎、大便失禁、克罗恩病的延迟诊断、瘘管、手术并发症、直肠残端过长、慢性脓肿以及手术技术失误。其中一些原因并不总是会导致功能良好的回肠肛管贮袋丧失。在许多情况下，可以进行矫正、瘘管闭合，甚至回肠肛管贮袋的完全重建。基于文献回顾和我们自己的经验，我们在887例患者中显示成功率为75%，贮袋功能可接受。本文介绍了手术指征、技术和结果。
