- Hospital das Clínicas- UFMG, Instituto Alfa de Gastroenterologia - Belo Horizonte - MG - Brasil.
- Universidade Federal de Minas Gerais, Departamento de Cirurgia - Belo Horizonte - MG - Brasil.
Rev Col Bras Cir. 2021 Mar 24;48:e20202791. doi: 10.1590/0100-6991e-20202791. eCollection 2021.
restorative proctocolectomy with ileal pouch-anal anastomosis (IPAA) is the surgical procedure of choice in some cases of familial adenomatous polyposis (FAP) and ulcerative colitis (UC). IPAA allows complete removal of the diseased colon and rectum, however, it is associated with substantial morbidity and potential consequences to patients' quality of life (QoL).
to evaluate the surgical results, functional outcomes and QoL after IPAA; and to examine the impact of surgical complications upon QoL.
we reviewed the records of 55 patients after IPAA, with emphasis on surgical outcomes. Forty patients answered the questionnaires. The Cleveland Global Quality of Life (CGQL), Inflammatory Bowel Disease Questionnaire (IBDQ), and Short Form 36 Health Survey Questionnaire (SF36).
the average age was 42.1±14.1 years. 63.6% of the patients were male, and 69.1% had FAP. Operative mortality was 1.8% and overall morbidity was 76.4%. Anastomotic leakage was the most frequent early complication (34.5%). Pouchitis (10.8%) and small bowel obstruction (9.1%) were the most common late complications. Patients with UC had the most severe complications (p=0.014). Pelvic complications did not have a negative effect on functional outcomes or QoL scores. Female patients had decreased pouch evacuation frequency, fewer nocturnal bowel movements, decreased bowel symptom impact on QoL (p=0.012), and better CGQL (p=0.04). Patients with better education had better QoL scores, and patients who had their pouches for more than five years scored lower.
the high morbidity has no impact on function or QoL. Bowel function is generally acceptable. QoL is good and affected by sex, education and time interval since IPAA.
回肠贮袋肛管吻合术（IPAA）是家族性腺瘤性息肉病（FAP）和溃疡性结肠炎（UC）等某些情况下的首选手术方法。IPAA 可彻底切除患病的结肠和直肠，但与较高的发病率和对患者生活质量（QoL）的潜在影响相关。
评估 IPAA 后的手术结果、功能结果和生活质量，并研究手术并发症对生活质量的影响。
我们回顾了 55 例 IPAA 后的患者记录，重点关注手术结果。40 例患者回答了问卷。使用克利夫兰全球生活质量量表（CGQL）、炎症性肠病问卷（IBDQ）和 36 项简短健康调查问卷（SF36）评估生活质量。
平均年龄为 42.1±14.1 岁。63.6%的患者为男性，69.1%患有 FAP。手术死亡率为 1.8%，总发病率为 76.4%。吻合口漏是最常见的早期并发症（34.5%）。储袋炎（10.8%）和小肠梗阻（9.1%）是最常见的晚期并发症。UC 患者的并发症最严重（p=0.014）。盆腔并发症对功能结果或生活质量评分没有负面影响。女性患者的储袋排空频率较低、夜间排便次数较少、对生活质量的肠道症状影响较小（p=0.012）、CGQL 评分较好（p=0.04）。教育程度较高的患者生活质量评分较好，储袋使用时间超过 5 年的患者评分较低。
高发病率对功能或生活质量没有影响。肠道功能普遍可接受。生活质量良好，受性别、教育程度和 IPAA 后时间间隔的影响。
