Ganschow Petra, Treiber Irmgard, Hinz Ulf, Kadmon Martina
Department of General, Visceral, and Transplant Surgery, University of Heidelberg, Heidelberg, Germany.
Department of General, Visceral, and Transplantation Surgery, Ludwig-Maximilians University, Marchionini-Str. 1581377, Munich, Germany.
Langenbecks Arch Surg. 2019 Mar;404(2):223-229. doi: 10.1007/s00423-018-1747-1. Epub 2019 Jan 24.
Restorative proctocolectomy and ileal pouch-anal reconstruction is the surgical standard for the majority of patients with familial adenomatous polyposis (FAP). The pouch-anal anastomosis may be performed handsewn after primary mucosectomy or by double stapling. Better functional results favour the latter; however, higher rates of remaining rectal mucosa with adenomas often necessitate secondary mucosectomy. Data on functional outcome after secondary mucosectomy is scarce. The aim of the study was to analyse whether patients who undergo secondary mucosectomy maintain their functional benefits compared to patients with primary mucosectomy.
Twenty patients after secondary mucosectomy and 31 patients after primary mucosectomy were compared with respect to their functional outcome, using the MSKCC score, the Wexner score and ano-rectal physiology testing.
The MSKCC global score and the Wexner score showed a non-significant trend towards slightly better results after secondary mucosectomy (63.1 vs. 56.6, p = 0.0188 and 9.5 vs. 11, p = 0.3780). Patients after secondary mucosectomy also showed a tendency towards less bowel movements per 24 h (7 (range 4-11) vs. 8.5 (range 3-20), p = 0.1518). Resting pressures were slightly higher after secondary (44 vs. 39.6 mmHg, p = 0.4545) and squeeze pressures slightly higher after primary mucosectomy (87.6 vs. 81.2 mmHg, p = 0.6126). However, the results did not reach statistical significance.
The results of this study cannot ultimately resolve the controversy concerning handsewn versus stapled ileal pouch-anal anastomosis. Our results suggest a trend towards better functional results after stapled anastomosis with secondary mucosectomy.
保留直肠结肠切除术及回肠储袋肛管吻合术是大多数家族性腺瘤性息肉病（FAP）患者的手术标准术式。肛管吻合可在初次黏膜切除术后手工缝合，也可采用双吻合器技术。功能结果更好支持后者；然而，残留直肠黏膜伴腺瘤的发生率较高常需再次行黏膜切除术。关于再次黏膜切除术后功能结局的数据较少。本研究的目的是分析再次行黏膜切除术的患者与初次行黏膜切除术的患者相比，是否能维持其功能获益。
采用纪念斯隆凯特琳癌症中心（MSKCC）评分、韦克斯纳评分及肛肠生理测试，比较20例再次行黏膜切除术的患者与31例初次行黏膜切除术的患者的功能结局。
MSKCC总体评分和韦克斯纳评分显示，再次行黏膜切除术后结果略好，但差异无统计学意义（63.1对56.6，p = 0.0188；9.5对11，p = 0.3780）。再次行黏膜切除术的患者每24小时排便次数也有减少趋势（7次（范围4 - 11次）对8.5次（范围3 - 20次），p = 0.1518）。再次行黏膜切除术后静息压力略高（44对39.6 mmHg，p = 0.4545），初次行黏膜切除术后挤压压力略高（87.6对81.2 mmHg，p = 0.6126）。然而，结果未达到统计学显著性。
本研究结果未能最终解决关于手工缝合与吻合器回肠储袋肛管吻合术的争议。我们的结果提示，吻合器吻合联合再次黏膜切除术后功能结果有改善趋势。
