St Mark's Hospital and Academic Institute, London North West Healthcare NHS Trust, Middlesex, United Kingdom.
Department of Surgery and Cancer, Imperial College London, London, United Kingdom.
Dis Colon Rectum. 2019 Apr;62(4):454-462. doi: 10.1097/DCR.0000000000001273.
Pouch excision is required for many of those patients experiencing pouch failure in whom ileostomy alone is inadequate and revision surgery is not appropriate. The published rate of pouch failure is approximately 10% at 10 years, resulting in a growing cohort of patients requiring excision.
In this article, we aim to describe the indications for excision and postoperative outcomes at our center since 2004.
This is a retrospective observational study.
This study was conducted at a tertiary referral center for ileal pouch dysfunction. Cases were documented from 2004 to 2017.
The cohort comprised 92 patients; 83% were diagnosed with ulcerative colitis, 15% with familial adenomatous polyposis, and 2% with indeterminate colitis.
Patients underwent excision of pelvic ileal pouches.
The primary outcomes measured were the time to perineal wound healing and healing at 6 months. Thirty- and 90-day morbidity and mortality were evaluated.
Postoperative histology was consistent with Crohn's disease in 1 patient. The median time from pouch creation to excision was 7 years. The rate of perineal wound healing at 6 months was 78%, and regression analysis demonstrated significantly improved chances of healing for noninfective indications for excision (p = 0.023; OR, 15.22; 95% CI, 1.45-160.27) and for more recent procedures (p = 0.032; OR, 12.00; 95% CI, 1.87-76.87).
This study was limited because it was retrospective in nature, and it was a single-center experience.
This study represents the most contemporary cohort of patients undergoing pouch excision surgery. The procedure retains a relatively high postoperative morbidity, but this study demonstrates a learning curve with improving perineal healing over time associated with a high institutional volume. Defunctioning ileostomy may improve perineal wound healing in patients with infective indications for excision. Further investigation is required to establish the quality-of-life benefits of pouch excision in this modern cohort. See Video Abstract at http://links.lww.com/DCR/A804.
对于许多经历 pouch 失败的患者，需要进行 pouch 切除术，这些患者单独行 ileostomy 是不够的，且 revision 手术也不适合。 pouch 失败的发表率约为 10%，10 年时，导致越来越多的患者需要切除 pouch。
本文旨在描述自 2004 年以来，我们中心因 pouch 失败而行 pouch 切除术的适应证和术后结果。
这是一项回顾性观察研究。
该研究在一家三级转介中心进行，用于治疗 ileal pouch 功能障碍。病例记录自 2004 年至 2017 年。
该队列包括 92 例患者，83%诊断为溃疡性结肠炎，15%为家族性腺瘤性息肉病，2%为不确定结肠炎。
患者行 pelvic ileal pouches 切除术。
主要观察指标是会阴伤口愈合时间和 6 个月时的愈合情况。评估 30 天和 90 天的发病率和死亡率。
术后组织学检查 1 例患者符合克罗恩病。从 pouch 创建到切除的中位时间为 7 年。6 个月时会阴伤口愈合率为 78%，回归分析显示，对于非感染性 pouch 切除适应证（p=0.023；OR，15.22；95%CI，1.45-160.27）和最近的手术（p=0.032；OR，12.00；95%CI，1.87-76.87），愈合的机会显著提高。
本研究为回顾性研究，且为单中心经验，存在一定局限性。
本研究代表了目前行 pouch 切除术患者中最新的队列。该手术的术后并发症发生率相对较高，但本研究表明，随着时间的推移，手术技术逐渐成熟，会阴愈合情况得到改善，且与机构较高的手术量有关。对于感染性 pouch 切除适应证的患者，预防性 ileostomy 可能会改善会阴伤口愈合。需要进一步研究来确定在这个现代队列中，pouch 切除术对生活质量的影响。详见原文视频摘要，网址：http://links.lww.com/DCR/A804。
