Jonker Jara E, Hofker Hendrik S, Trzpis Monika, Broens Paul M A
Department of Surgery, Anorectal Physiology Laboratory, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
Department of Surgery, Division of Abdominal Surgery , University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
Int J Colorectal Dis. 2020 Sep;35(9):1749-1757. doi: 10.1007/s00384-020-03626-7. Epub 2020 May 30.
This study aims to analyze the quality of life in patients with an ileal pouch-anal anastomosis (IPAA) and to investigate the association between height and type of the anastomosis, the number of stage procedures and age, and the fecal continence outcomes.
This is a cross-sectional retrospective study in patients who had undergone IPAA between 1992 and 2016 (N = 133). We sent questionnaires to 102 eligible patients (64% response rate). We used the Wexner score to assess fecal incontinence: 0 = no incontinence to 20 = complete incontinence. We used RAND-36 to measure quality of life.
Patients who underwent mucosectomy with hand-sewn anastomoses (n = 11, 17%) had significantly higher median Wexner scores than patients with stapled anastomoses (10 versus 3, P = 0.003). Lower anastomoses correlated significantly with increasing Wexner scores (r = - 0.468, P < 0.001). Quality of life of incontinent patients was diminished. Patients who were older at the time of IPAA surgery had higher Wexner scores (P = 0.004), while the time between surgery and questionnaire did not influence their Wexner scores (P = 0.810). Considering the stage procedures, multiple linear regression showed that the two-stage procedure without diverting ileostomy was significantly associated with higher Wexner scores (B = 0.815, P = 0.02), adjusted for sex (P = 0.008) and anastomosis type (P = 0.002). The three-stage procedure showed equally low complications and anastomotic leakage rates.
Mucosectomy with more distal, hand-sewn anastomosis and increasing age at IPAA surgery was associated with poorer fecal continence outcomes. The three-stage procedure appears to give the best fecal continence results without increasing complications. Furthermore, incontinence reduced patient's quality of life.
本研究旨在分析回肠储袋肛管吻合术（IPAA）患者的生活质量，并探讨吻合术的高度和类型、分期手术次数与年龄之间的关联以及大便失禁的结果。
这是一项对1992年至2016年间接受IPAA手术的患者（N = 133）进行的横断面回顾性研究。我们向102名符合条件的患者发送了问卷（回复率为64%）。我们使用韦克斯纳评分来评估大便失禁情况：0分表示无失禁，20分表示完全失禁。我们使用兰德36项健康调查量表来测量生活质量。
接受黏膜切除手工缝合吻合术的患者（n = 11，17%）的韦克斯纳评分中位数显著高于接受吻合器吻合术的患者（分别为10分和3分，P = 0.003）。低位吻合与韦克斯纳评分增加显著相关（r = - 0.468，P < 0.001）。失禁患者的生活质量下降。IPAA手术时年龄较大的患者韦克斯纳评分较高（P = 0.004），而手术与问卷调查之间的时间间隔对其韦克斯纳评分没有影响（P = 0.810）。考虑分期手术，多元线性回归显示，在调整性别（P = 0.008）和吻合术类型（P = 0.002）后，未行转流性回肠造口术的两期手术与较高的韦克斯纳评分显著相关（B = 0.815，P = 0.02）。三期手术的并发症和吻合口漏率同样较低。
IPAA手术时采用更低位的手工缝合吻合术及黏膜切除且年龄增加与较差的大便失禁结果相关。三期手术似乎能在不增加并发症的情况下取得最佳的大便失禁效果。此外，失禁会降低患者的生活质量。
