Helavirta Ilona, Lehto Kirsi, Huhtala Heini, Hyöty Marja, Collin Pekka, Aitola Petri
Department of Gastroenterology and Alimentary Tract Surgery, Tampere University Hospital, Teiskontie 35, FI-33521, Tampere, Finland.
Faculty of Medicine and Health Technology, Tampere University, P.O. Box 100, FI-33014, Tampere, Finland.
Int J Colorectal Dis. 2020 Nov;35(11):2027-2033. doi: 10.1007/s00384-020-03680-1. Epub 2020 Jun 26.
Restorative proctocolectomy (RPC) is the most common operation in ulcerative colitis. Nevertheless, permanent ileostomy will sometimes be unavoidable. The aim was to evaluate the reasons for pouch failure and early morbidity after pouch excision.
The number and the reasons for pouch failures were analysed in patients undergoing RPC 1985-2016.
Out of 491 RPC patients, 53 experienced pouch failure (10 women, 43 men); 52 out of 53 underwent pouch excision. The cumulative risk for excision at 5, 10 and 20 years was 5.6, 9.4 and 15.5%, respectively. The reasons for failure included septic events such as fistula in 12 (23%), chronic pouchitis in 11 (21%) and leakage in 8 (15%) patients. Functional reasons for pouch failure were recorded as poor function in 16 (30%), incontinence in 12 (23%) and stricture in 12 (23%) patients. Multiple causes for pouch failure were recorded for individual patients. Seven cases of Crohn's disease were found among the failure cases: two before pouch excision and five after. Altogether, 15 Crohn's disease diagnoses were set in the RPC cohort, giving a percentage of 47% of pouch failure in this disorder. A complication occurred in 23 (44%) patients within 30 days after surgery; 16 were mild (Clavien-Dindo grades I-II).
Eleven percent of RPC patients suffered pouch failure: more men than women. The reasons were multiple. Crohn's disease created a risk of failure, but a half of these patients maintained the pouch. Morbidity after pouch excision was moderate, but in most cases slight.
全直肠系膜切除回肠储袋肛管吻合术（RPC）是溃疡性结肠炎最常见的手术方式。然而，永久性回肠造口术有时仍不可避免。本研究旨在评估储袋切除术后储袋功能衰竭及早期发病的原因。
分析1985年至2016年期间接受RPC手术患者的储袋功能衰竭数量及原因。
491例RPC患者中，53例出现储袋功能衰竭（女性10例，男性43例）；53例中有52例行储袋切除术。5年、10年和20年的储袋切除累积风险分别为5.6%、9.4%和15.5%。功能衰竭的原因包括感染性事件，如12例（23%）出现瘘管、11例（21%）出现慢性储袋炎、8例（15%）出现渗漏。储袋功能衰竭的功能性原因记录为16例（30%）功能差、12例（23%）大便失禁、12例（23%）出现狭窄。个别患者存在多种导致储袋功能衰竭的原因。在功能衰竭病例中发现7例克罗恩病：2例在储袋切除术前，5例在术后。RPC队列中总共确诊15例克罗恩病，占该疾病储袋功能衰竭的47%。23例（44%）患者术后30天内出现并发症；16例为轻度（Clavien-Dindo分级I-II级）。
11%的RPC患者出现储袋功能衰竭，男性多于女性。原因是多方面的。克罗恩病会增加储袋功能衰竭的风险，但其中一半患者保留了储袋。储袋切除术后发病率为中度，但大多数情况下较轻。
