Department of Digestive Surgery, University Hospital of Nancy, Nancy, France.
Department of Abdominal Surgery, University Hospitals Leuven, Leuven, Belgium.
Colorectal Dis. 2018 Feb;20(2):O30-O38. doi: 10.1111/codi.13948.
Surgery for ileal pouch-anal anastomosis (IPAA) has evolved over time, especially since the introduction of laparoscopy. The aim of this retrospective study was to report the impact of surgical evolution on outcome over a period of 25 years.
All patients who had IPAA surgery for ulcerative colitis from 1990 to 2015 at the University Hospitals of Leuven were included. Patients were divided into three period arms (period A 1990-1999; period B 2000-2009; period C 2010-2015). The main outcome measure was anastomotic leakage.
A total of 335 patients (58.8% male) with a median age of 39 years (interquartile range 32-49 years) at surgery were included. Median follow-up was 5 years (interquartile range 2-10 years). Overall anastomotic leakage (grades A-C) was 14.9%. A significant decrease in leakage rate was observed over time (from 21.4% in period A to 12.1% in period B to 10.0% in period C; P = 0.04). The defunctioning ileostomy rate at the time of pouch construction decreased from 91.7% (period A) to 40.3% (period B) to 11.1% (period C) (P < 0.001). We observed an increase in the use of laparoscopy (23.9% in period A vs 72.6% in period B, vs 84.4% in period C; P = 0.001) and a shift to a modified two-stage procedure (4.1% in period A, vs 66.7% in period C; P < 0.0001). In a monocentric study with some of the data retrieved retrospectively it was not possible to account for the impact of preoperative nutritional status (weight loss, serum albumin level) or disease burden. Other outcome factors were not measured, for example sexual function and fecundity.
A higher rate of laparoscopic IPAA surgery, together with a shift towards modified two-stage procedures, was associated with a lower leakage rate despite a reduction in the use of defunctioning ileostomy.
回肠贮袋肛管吻合术（IPAA）的手术随着时间的推移而演变，尤其是自从引入腹腔镜手术以来。本回顾性研究的目的是报告 25 年来手术演变对结果的影响。
纳入 1990 年至 2015 年在鲁汶大学医院接受溃疡性结肠炎 IPAA 手术的所有患者。患者被分为三个时期（A 期 1990-1999 年；B 期 2000-2009 年；C 期 2010-2015 年）。主要观察指标是吻合口漏。
共纳入 335 例患者（58.8%为男性），手术时的中位年龄为 39 岁（四分位间距 32-49 岁）。中位随访时间为 5 年（四分位间距 2-10 年）。总体吻合口漏（A-C 级）发生率为 14.9%。吻合口漏发生率随时间显著下降（从 A 期的 21.4%降至 B 期的 12.1%和 C 期的 10.0%；P=0.04）。造袋时预防性回肠造口术的使用率从 91.7%（A 期）降至 40.3%（B 期）和 11.1%（C 期）（P<0.001）。我们观察到腹腔镜手术的使用率增加（A 期为 23.9%，B 期为 72.6%，C 期为 84.4%；P=0.001）和向改良两阶段手术转变（A 期为 4.1%，C 期为 66.7%；P<0.0001）。在一项部分数据回顾性获取的单中心研究中，无法考虑术前营养状况（体重减轻、血清白蛋白水平）或疾病负担的影响。其他结果因素未被测量，例如性功能和生育能力。
尽管预防性回肠造口术的使用率降低，但更高比例的腹腔镜 IPAA 手术和向改良两阶段手术转变，与吻合口漏发生率降低相关。
