Lian Lei, Obusez Emmanuel, Remer Erick M, Monga Manoj, Shen Bo
Department of Gastroenterology and Hepatology, The Cleveland Clinic Foundation, Cleveland, OH 44195, USA.
Department of Colorectal Surgery, The Cleveland Clinic Foundation, Cleveland, OH 44195, USA.
Gastroenterology Res. 2018 Feb;11(1):5-10. doi: 10.14740/gr975e. Epub 2018 Feb 23.
Enlarged prostate is often noticed in patients with ileal pouch-anal anastomosis (IPAA) in our clinical practice. The aims were to identify the factors associated with enlarged prostate and to investigate its clinical implications.
IPAA patients with available prostate imaging after IPAA were included. Prostate length and width were measured in the axial plane and height in coronal plane. Prostate volume was calculated with the formula (length × width × height) × π/6. A volume greater than 40 cm was used to define enlarged prostate.
Prostate enlargement was found in 58 (24.8%) out of 234 patients. Factors associated with prostate enlargement included advanced age at imaging examination (55.6 ± 11.5 vs. 41.3 ± 13.6 years, P < 0.0001), age at pouch surgery (46.0 ± 11.8 vs. 32.5 ± 12.9 years, P<0.0001), and the presence of an S-pouch (6.9% vs. 1.1%, P = 0.03). Postoperative use of biologics was less common in patients with enlarged prostate (5.2% vs. 17%, P = 0.03). However, pouch duration was comparable (10.0 ± 5.9 vs. 8.8 ± 6.8 years, P = 0.2) and pouch failure rate was similar. A trend towards an increased risk for acute pouchitis in patients with enlarged prostate was noticed (19% vs. 9.1%, P = 0.06). The association of S-pouch (odds ratio: 7.2, 95% confidence interval: 1.1 - 46.4) and enlarged prostate remained significant after adjusting for age, acute pouchitis, and redo pouch on multivariate analysis.
Prostate enlargement appears to be uncommon after IPAA and it was associated with S-pouch configuration and advanced age. Enlarged prostate in the setting of IPAA does not seem to have adverse impact on pouch outcomes, although there is a trend in correlation between enlarged prostate and acute pouchitis.
在我们的临床实践中，回肠储袋肛管吻合术（IPAA）患者常出现前列腺增大。目的是确定与前列腺增大相关的因素，并研究其临床意义。
纳入IPAA术后有可用前列腺影像学检查的患者。在轴位平面测量前列腺的长度和宽度，在冠状位平面测量高度。前列腺体积用公式（长度×宽度×高度）×π/6计算。体积大于40 cm³定义为前列腺增大。
234例患者中有58例（24.8%）出现前列腺增大。与前列腺增大相关的因素包括影像学检查时的高龄（55.6±11.5岁对41.3±13.6岁，P<0.0001）、储袋手术时的年龄（46.0±11.8岁对32.5±12.9岁，P<0.0001）以及S形储袋的存在（6.9%对1.1%，P = 0.03）。前列腺增大的患者术后使用生物制剂的情况较少见（5.2%对17%，P = 0.03）。然而，储袋使用时间相当（10.0±5.9年对8.8±6.8年，P = 0.2），储袋失败率相似。注意到前列腺增大的患者急性储袋炎风险有增加趋势（19%对9.1%，P = 0.06）。在多变量分析中，调整年龄、急性储袋炎和再次手术储袋后，S形储袋与前列腺增大的关联（比值比：7.2，95%置信区间：1.1 - 46.4）仍然显著。
IPAA术后前列腺增大似乎不常见，且与S形储袋构型和高龄有关。IPAA情况下的前列腺增大似乎对储袋结局没有不利影响，尽管前列腺增大与急性储袋炎之间存在相关趋势。
