Department of Medicine, Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
Inflamm Bowel Dis. 2020 Jun 18;26(7):1079-1086. doi: 10.1093/ibd/izz227.
Total proctocolectomy (TPC) with ileal pouch anal anastomosis (IPAA) is the gold standard surgery for ulcerative colitis (UC) patients with medically refractory disease. The aim of this study was to report the rates and risk factors of inflammatory pouch conditions.
This was a retrospective review of UC or IBD unspecified (IBDU) patients who underwent TPC with IPAA for refractory disease or dysplasia between 2008 and 2017. Pouchoscopy data were used to calculate rates of inflammatory pouch conditions. Factors associated with outcomes in univariable analysis were investigated in multivariable analysis.
Of the 621 patients more than 18 years of age who underwent TPC with IPAA between January 2008 and December 2017, pouchoscopy data were available for 386 patients during a median follow-up period of 4 years. Acute pouchitis occurred in 205 patients (53%), 60 of whom (30%) progressed to chronic pouchitis. Cuffitis and Crohn's disease-like condition (CDLC) of the pouch occurred in 119 (30%) patients and 46 (12%) patients, respectively. In multivariable analysis, female sex was associated with a decreased risk of acute pouchitis, and pre-operative steroid use and medically refractory disease were associated with an increased risk; IBDU was associated with chronic pouchitis; rectal cuff length ≥2 cm and medically refractory disease were associated with cuffitis; age 45-54 at colectomy was associated with CDLC. Rates of pouch failure were similar in chronic pouchitis and CDLC patients treated with biologics and those who were not.
Inflammatory pouch conditions are common. Biologic use for chronic pouchitis and CDLC does not impact the rate of pouch failure.
全直肠结肠切除（TPC）联合回肠储袋肛管吻合术（IPAA）是对药物难治性疾病的溃疡性结肠炎（UC）患者的金标准手术。本研究的目的是报告炎症性储袋疾病的发生率和危险因素。
这是一项回顾性研究，纳入了 2008 年至 2017 年间因难治性疾病或异型增生而行 TPC 联合 IPAA 的 UC 或未特指炎症性肠病（IBDU）患者。使用储袋内镜数据计算炎症性储袋疾病的发生率。在单变量分析中，对与结局相关的因素进行了多变量分析。
在 2008 年 1 月至 2017 年 12 月期间，621 例年龄超过 18 岁的患者接受了 TPC 联合 IPAA，其中 386 例在中位 4 年的随访期间有储袋内镜数据。205 例（53%）患者发生急性储袋炎，其中 60 例（30%）进展为慢性储袋炎。119 例（30%）和 46 例（12%）患者发生了吻合口炎和储袋克罗恩病样疾病（CDLC）。多变量分析显示，女性发生急性储袋炎的风险降低，术前使用激素和药物难治性疾病的风险增加；IBDU 与慢性储袋炎相关；直肠吻合口长度≥2cm 和药物难治性疾病与吻合口炎相关；结肠切除时年龄 45-54 岁与 CDLC 相关。接受生物制剂治疗的慢性储袋炎和 CDLC 患者与未接受治疗的患者相比，储袋失败的发生率无差异。
炎症性储袋疾病很常见。生物制剂治疗慢性储袋炎和 CDLC 并不影响储袋失败的发生率。
