Department of Inflammatory Bowel Disease, Hyogo College of Medicine, 1-1, Mukogawa-cho, Nishinomiya, Hyogo, 663-8501, Japan.
Department of Inflammatory Bowel Disease, Yokohama Municipal Citizen's Hospital, Yokohama, Japan.
J Gastroenterol. 2018 May;53(5):642-651. doi: 10.1007/s00535-017-1389-z. Epub 2017 Sep 7.
Although several complications capable of causing pouch failure may develop after restorative proctocolectomy (RPC) for ulcerative colitis (UC), the incidences and causes are conflicting and vary according to country, race and institution. To avoid pouch failure, this study aimed to evaluate the rate of pouch failure and its risk factors in UC patients over the past decade via a nationwide cohort study.
We conducted a retrospective, observational, multicenter study that included 13 institutions in Japan. Patients who underwent RPC between January 2005 and December 2014 were included. The characteristics and backgrounds of the patients before and during surgery and their postoperative courses and complications were reviewed.
A total of 2376 patients were evaluated over 6.7 ± 3.5 years of follow-up. Twenty-seven non-functional pouches were observed, and the functional pouch rate was 98.9% after RPC. Anastomotic leakage (odds ratio, 9.1) was selected as a risk factor for a non-functional pouch. The cumulative pouch failure rate was 4.2%/10 years. A change in diagnosis to Crohn's disease/indeterminate colitis (hazard ratio, 13.2) was identified as an independent risk factor for pouch failure.
The significant risk factor for a non-functional pouch was anastomotic leakage. The optimal staged surgical procedure should be selected according to a patient's condition to avoid anastomotic failure during RPC. Changes in diagnosis after RPC confer a substantial risk of pouch failure. Additional cohort studies are needed to obtain an understanding of the long-standing clinical course of and proper treatment for pouch failure.
尽管溃疡性结肠炎（UC）患者行直肠结肠切除术（RPC）后可能会出现几种导致袋状结构失败的并发症，但这些并发症的发生率和病因存在争议，且因国家、种族和机构而异。为了避免袋状结构失败，本研究通过一项全国性队列研究，旨在评估过去十年中 UC 患者袋状结构失败的发生率及其危险因素。
我们进行了一项回顾性、观察性、多中心研究，纳入了日本的 13 家机构。纳入 2005 年 1 月至 2014 年 12 月期间行 RPC 的患者。回顾了患者手术前后的特征和背景，以及他们的术后过程和并发症。
在 6.7±3.5 年的随访期间，共评估了 2376 例患者。观察到 27 例非功能性袋状结构，RPC 后功能性袋状结构率为 98.9%。吻合口漏（比值比，9.1）被选为非功能性袋状结构的危险因素。累积袋状结构失败率为 4.2%/10 年。诊断改变为克罗恩病/不确定结肠炎（风险比，13.2）被确定为袋状结构失败的独立危险因素。
非功能性袋状结构的显著危险因素是吻合口漏。在 RPC 时，应根据患者的情况选择最佳的分期手术程序，以避免吻合口失败。RPC 后诊断的改变是袋状结构失败的一个重要危险因素。需要进一步的队列研究来了解袋状结构失败的长期临床病程和适当的治疗方法。
