对于慢性溃疡性结肠炎患者，回肠造口关闭术前的常规袋状结肠镜检查可能并非必要。

Routine Pouchoscopy Prior to Ileostomy Takedown May Not Be Necessary in Patients with Chronic Ulcerative Colitis.

作者信息

Cai Jennifer X, Barrow Jasmine, Parian Alyssa, Brant Steven R, Dudley-Brown Sharon, Efron Jonathan, Fang Sandy, Gearhart Susan, Marohn Michael, Safar Bashar, Truta Brindusa, Wick Elizabeth, Lazarev Mark

机构信息

Department of Medicine, Division of Gastroenterology and Hepatology, Meyerhoff Inflammatory Bowel Disease Center, Johns Hopkins Medical Institutions, Baltimore, MD, USA.

出版信息

Dig Dis. 2018;36(1):72-77. doi: 10.1159/000475808. Epub 2017 Jun 9.

DOI:10.1159/000475808

PMID:28595172

Abstract

BACKGROUND

Creation of a J pouch is the gold standard surgical intervention in the treatment of chronic ulcerative colitis (UC). Pouchoscopy prior to ileostomy takedown is commonly performed. We describe the frequency, indication, and findings on pouchoscopy, and determine if pouchoscopy affects rates of complications after takedown.

METHODS

All UC or indeterminate inflammatory bowel disease patients with a J pouch were retrospectively evaluated from January 1994 to December 2014. Cases were defined as having routine (asymptomatic) pouchoscopy after pouch creation but before ileostomy takedown. Controls were defined as having no pouchoscopy or pouchoscopy on the same day as that of takedown.

RESULTS

The study included 178 patients (81.5% cases, 18.5% controls). Fifty two percent of pouchoscopies were reported as normal. Common abnormal endoscopy findings included stricture (35%), pouchitis (7%), and cuffitis (0.7%). Length of stay during takedown hospitalization was shorter for cases than controls (3 vs. 5 days; p = 0.001), but neither short- nor long-term complications were statistically different between cases and controls. Abnormalities on pouchoscopy were not predictive for short-term complications (p = 0.73) or long-term complications (p = 0.55). Routine pouchoscopy did not delay takedown surgery in any of the included patients.

CONCLUSIONS

Routine pouchoscopy may not be necessary prior to ileostomy takedown; its greatest utility is in patients with suspected pouch complications.

摘要

背景

创建J形贮袋是治疗慢性溃疡性结肠炎（UC）的金标准手术干预措施。回肠造口术关闭前通常会进行贮袋内镜检查。我们描述了贮袋内镜检查的频率、适应证及检查结果，并确定贮袋内镜检查是否会影响关闭术后的并发症发生率。

方法

对1994年1月至2014年12月期间所有患有J形贮袋的UC或不确定性炎症性肠病患者进行回顾性评估。病例定义为在创建贮袋后但在回肠造口术关闭前进行常规（无症状）贮袋内镜检查。对照组定义为未进行贮袋内镜检查或在关闭当天进行贮袋内镜检查。

结果

该研究纳入了178例患者（81.5%为病例组，18.�%为对照组）。52%的贮袋内镜检查报告为正常。常见的异常内镜检查结果包括狭窄（35%）、贮袋炎（7%）和袖口炎（0.7%）。病例组在关闭住院期间的住院时间比对照组短（3天对5天；p = 0.001），但病例组和对照组的短期和长期并发症在统计学上均无差异。贮袋内镜检查的异常结果对短期并发症（p = 0.73）或长期并发症（p = 0.55）均无预测价值。常规贮袋内镜检查未导致纳入研究的任何患者的关闭手术延迟。