Sunde M L, Negård A, Øresland T, Bakka N, Geitung J T, Færden A E
Department of Colorectal Surgery, Akershus University Hospital, 1478, Lørenskog, Norway.
Division of Surgical Sciences, Faculty of Medicine, University of Oslo, Oslo, Norway.
Int J Colorectal Dis. 2018 May;33(5):609-617. doi: 10.1007/s00384-018-3011-0. Epub 2018 Mar 9.
Variability in functional outcome after ileal pouch-anal anastomosis (IPAA) is to a large extent unexplained. The aim of this study was to use MRI to evaluate the morphology, emptying pattern and other pathology that may explain differences in functional outcome between well-functioning and poorly functioning pouch patients. A secondary aim was to establish a reference of normal MRI findings in pelvic pouch patients.
From a previous study, the best and worst functioning patients undergoing IPAA surgery between 2000 and 2013 had been identified and examined with manovolumetric tests (N = 47). The patients were invited to do a pelvic MRI investigating pouch morphology and emptying patterns, followed by a pouch endoscopy.
Forty-three patients underwent MRI examination. We found no significant morphological or dynamic differences between the well-functioning and poorly functioning pouch patients. There was no correlation between urge volume and the volume of the bony pelvis, and no correlation between emptying difficulties or leakage and dynamic MRI findings. Morphological MRI signs of inflammation were present in the majority of patients and were not correlated to histological signs of inflammation. Of the radiological signs of inflammation, only pouch wall thickness correlated to endoscopic pouchitis disease activity index scores.
It seems MRI does not increase the understanding of factors contributing to functional outcome after ileal pouch-anal anastomosis. Unless there is a clinical suspicion of perianal/peripouch disease or pelvic sepsis, MRI does not add value as a diagnostic tool for pelvic pouch patients. Endoscopy remains the golden standard for diagnosing pouch inflammation.
回肠储袋肛管吻合术（IPAA）后功能结局的变异性在很大程度上无法解释。本研究的目的是使用磁共振成像（MRI）评估形态、排空模式及其他病理学特征，以解释功能良好和功能不良的储袋患者之间功能结局的差异。次要目的是建立盆腔储袋患者正常MRI表现的参考标准。
从之前的一项研究中，确定了2000年至2013年间接受IPAA手术的功能最佳和最差的患者，并进行了压力容积测试（N = 47）。邀请这些患者进行盆腔MRI检查，以研究储袋形态和排空模式，随后进行储袋内镜检查。
43例患者接受了MRI检查。我们发现功能良好和功能不良的储袋患者之间在形态或动力学方面没有显著差异。尿急容量与骨盆体积之间没有相关性，排空困难或渗漏与MRI动态表现之间也没有相关性。大多数患者存在炎症的形态学MRI征象，且与炎症的组织学征象无关。在炎症的放射学征象中，只有储袋壁厚度与内镜下储袋炎疾病活动指数评分相关。
似乎MRI并不能增进对回肠储袋肛管吻合术后功能结局影响因素的理解。除非临床上怀疑有肛周/储袋周围疾病或盆腔脓毒症，否则MRI作为盆腔储袋患者的诊断工具并无附加价值。内镜检查仍然是诊断储袋炎症的金标准。
