Soper N J, Kestenberg A, Becker J M
Department of Surgery, Washington University School of Medicine, St. Louis, Missouri 63110.
Dis Colon Rectum. 1988 Mar;31(3):186-9. doi: 10.1007/BF02552544.
Endorectal ileal pouch-anal anastomosis has become the surgical alternative of choice for patients requiring colectomy for ulcerative colitis or familial polyposis coli. The optimal method of ileal pouch construction has not been determined. In this study, a canine preparation was used to compare the immediate results of three different techniques of ileal J-pouch construction. The three methods studied were two-layer hand-suturing (HS), stapling through enterotomies placed laterally on the ileal limbs (LS), and stapling via an apically placed enterotomy (AS). All three techniques resulted in watertight reservoirs. Ease of construction was scored significantly differently among the pouch variations (AS greater than LS greater than HS). Construction time was significantly less for both of the stapled reservoirs than for the HS pouch. Capacity of the AS pouch was significantly greater than the HS reservoir. This study suggests that stapling the ileal J-pouch through a single apical enterotomy should be the preferred technique during colectomy, mucosal proctectomy, and ileal pouch-anal anastomosis.
直肠内回肠贮袋肛管吻合术已成为因溃疡性结肠炎或家族性腺瘤性息肉病而需要行结肠切除术患者的首选手术方式。回肠贮袋构建的最佳方法尚未确定。在本研究中，采用犬类模型来比较三种不同回肠J形贮袋构建技术的即刻效果。所研究的三种方法分别是两层手工缝合（HS）、通过在回肠肠段外侧做肠切开进行吻合器吻合（LS）以及通过在顶端做肠切开进行吻合器吻合（AS）。所有三种技术均形成了无渗漏的贮袋。在不同贮袋构建方式之间，构建的难易程度评分差异显著（AS大于LS大于HS）。两种吻合器吻合的贮袋构建时间均显著短于手工缝合的贮袋。AS贮袋的容量显著大于手工缝合的贮袋。本研究表明，在结肠切除术、黏膜直肠切除术及回肠贮袋肛管吻合术中，通过单个顶端肠切开进行回肠J形贮袋吻合术应是首选技术。
