Chang Shannon, Shen Bo, Remzi Feza
Dr Chang is an assistant professor of medicine at the Inflammatory Bowel Disease Center at New York University Langone Medical Center in New York, New York. Dr Shen is a professor of medicine at the Center for Inflammatory Bowel Diseases at the Digestive Disease and Surgery Institute at The Cleveland Clinic Foundation in Cleveland, Ohio. Dr Remzi is a professor of surgery and director of the Inflammatory Bowel Disease Center at New York University Langone Medical Center.
Gastroenterol Hepatol (N Y). 2017 Aug;13(8):466-475.
Ileal pouch-anal anastomosis (IPAA) is the preferred surgical treatment for patients who undergo colectomy and wish to avoid a permanent ileostomy. The overall outcomes are positive, with an improved quality of life and stable long-term pouch retention. However, certain conditions or disease states may be at a higher risk of pouch dysfunction or failure. For example, obese patients have an increased risk for postoperative complications. In addition, women with a history of obstetric complications and elderly patients with a history of sphincter damage or dysfunction may be at an increased risk for postoperative incontinence, although quality-of-life indices do not necessarily correlate with incontinence scores. Advanced age itself is not a contraindication to pouch surgery, and elderly patients can be considered for IPAA based on individual functionality and comorbidities. Pelvic radiation may lead to pouch dysfunction. Finally, patients with Crohn's disease and indeterminate colitis may have increased complications with IPAA, but highly specific patient selection leads to good rates of pouch retention. This article examines several clinical scenarios that require careful thought prior to considering IPAA.
回肠贮袋肛管吻合术（IPAA）是接受结肠切除术且希望避免永久性回肠造口术的患者的首选手术治疗方法。总体结果是积极的，生活质量得到改善，贮袋长期保留稳定。然而，某些情况或疾病状态可能发生贮袋功能障碍或失败的风险更高。例如，肥胖患者术后并发症的风险增加。此外，有产科并发症病史的女性和有括约肌损伤或功能障碍病史的老年患者术后尿失禁的风险可能增加，尽管生活质量指标不一定与尿失禁评分相关。高龄本身并非贮袋手术的禁忌证，根据个体功能和合并症情况，老年患者可考虑行IPAA。盆腔放疗可能导致贮袋功能障碍。最后，克罗恩病和不确定性结肠炎患者行IPAA可能有更多并发症，但严格的患者选择可使贮袋保留率良好。本文探讨了几种在考虑IPAA之前需要仔细权衡的临床情况。
