Kuwahara Ryuichi, Ikeuchi Hiroki, Bando Toshihiro, Sasaki Hirohumi, Goto Yoshiko, Horio Yuki, Minagawa Tomohiro, Uchino Motoi
Department of Gastroenterology, Division of Inflammatory Bowel Disease, Hyogo College of Medicine, Nisinomiya, Japan.
J Anus Rectum Colon. 2020 Oct 29;4(4):181-185. doi: 10.23922/jarc.2020-003. eCollection 2020.
Restorative proctocolectomy and ileal pouch anal anastomosis (IPAA), with diverting ileostomy, are established ulcerative colitis (UC) treatments. The routine use of diverting ileostomy is controversial because of the risk of stoma closure and stoma related complications. In our institution, proctocolectomy and IPAA, with mucosectomy and handsewn anastomosis without diversion (one-stage IPAA), were performed for select patients with UC. The present study aimed to evaluate the clinical and functional outcomes of patients undergoing one-stage IPAA.
Between April 1999 and July 2017, 300 patients underwent one-stage IPAA in our institution. The clinical notes and prognosis were reviewed retrospectively.
Postoperative complications (Clavien-Dindo classification grade ≥III) occurred in 18 patients (6.0%). The most common complication was anastomotic leakage (n = 9, 3%). There were 15 patients (5.0%) who required a defunctioning ileostomy. However, 13 patients successfully underwent ileostomy closure and achieved acceptable pouch function. Finally, two patients (0.6%) required pouch excision in this series. The cumulative pouch functional rate was 99.6% / 5 years and 99.2% / 10 years.
One-stage IPAA is a good strategy for carefully selected patients with UC.
保留回肠造口的全直肠系膜切除及回肠贮袋肛管吻合术（IPAA）是溃疡性结肠炎（UC）的既定治疗方法。由于存在造口关闭及造口相关并发症的风险，常规使用回肠造口存在争议。在我们机构，对部分UC患者实施了全直肠系膜切除及IPAA，包括黏膜切除和手工缝合吻合且不做转流（一期IPAA）。本研究旨在评估接受一期IPAA患者的临床和功能结局。
1999年4月至2017年7月期间，300例患者在我们机构接受了一期IPAA手术。对临床记录和预后进行回顾性分析。
18例患者（6.0%）发生术后并发症（Clavien-Dindo分级≥III级）。最常见的并发症是吻合口漏（n = 9，3%）。有15例患者（5.0%）需要行去功能化回肠造口术。然而，13例患者成功关闭了回肠造口并获得了可接受的贮袋功能。最终，本系列中有2例患者（0.6%）需要切除贮袋。5年和10年的累积贮袋功能率分别为99.6%和99.2%。
一期IPAA对于精心挑选的UC患者是一种良好的治疗策略。
