Hagihara Kiyotaka, Mori Ryota, Sekido Yuki, Ogino Takayuki, Hata Tsuyoshi, Takahashi Hidekazu, Miyoshi Norikatsu, Uemura Mamoru, Doki Yuichiro, Eguchi Hidetoshi, Mizushima Tsunekazu
Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Suita, Japan.
Department of Gastroenterological Surgery, Kawanishi City Hospital, Kawanishi, Japan.
J Laparoendosc Adv Surg Tech A. 2021 Sep 27. doi: 10.1089/lap.2021.0465.
Defecation status is an important determinant of quality of life. Previous studies showed that postoperative defecation disorders occurred after open surgery for ulcerative colitis (UC), but few have investigated defecation status after laparo-assisted surgery. The added precision and magnification provided with laparo-assisted surgery should lead to less damage to the anal sphincter muscle. This study investigated defecation function after a laparo-assisted restorative proctocolectomy (RPC) with ileal pouch anal anastomosis (IPAA). We also clarified factors that worsened defecation status. This retrospective study included 57 patients who underwent laparo-assisted RPC with IPAA for UC from January 2000 to May 2019. At 1 year after surgery, functional outcomes were evaluated with the Kirwan classification and Wexner score. Risk factors for poor defecation status were investigated with multiple regression. At 1 year after surgery, the median Kirwan classification score was 2 and the median Wexner score was 8. Defecation disorder was observed in 19 (33.3%) patients, according to the Kirwan classification, and 15 (26.3%) patients, according to the Wexner score. Hand-sewn IPAA was associated with defecation disorder ( = .04), evaluated with the Kirwan classification. Hand-sewn IPAA ( = .01), older age ( = .03), high body mass index ( = .04), and the surgical indication (cancer/dysplasia; = .03) were significantly associated with defecation disorder, evaluated with the Wexner score. The multivariable analysis showed that hand-sewn IPAA was an independent risk factor ( = .049; odds ratio: 4.99; 95% confidence interval: 1.0-28.39). We found that hand-sewn IPAA was a risk factor for defecation disorders after laparo-assisted RPC for UC.
排便状况是生活质量的重要决定因素。先前的研究表明，溃疡性结肠炎（UC）开放手术后会出现术后排便障碍，但很少有研究调查腹腔镜辅助手术后的排便状况。腹腔镜辅助手术所提供的更高精确度和放大效果应会减少对肛门括约肌的损伤。本研究调查了腹腔镜辅助保留回肠袋肛管吻合术（IPAA）的直肠结肠全切除术（RPC）后的排便功能。我们还阐明了使排便状况恶化的因素。这项回顾性研究纳入了2000年1月至2019年5月期间因UC接受腹腔镜辅助RPC联合IPAA手术的57例患者。术后1年，采用柯万分类法和韦克斯纳评分评估功能结局。采用多元回归分析排便状况不佳的危险因素。术后1年，柯万分类法评分中位数为2，韦克斯纳评分中位数为8。根据柯万分类法，19例（33.3%）患者存在排便障碍；根据韦克斯纳评分，15例（26.3%）患者存在排便障碍。采用柯万分类法评估，手工缝合IPAA与排便障碍相关（P = 0.04）。采用韦克斯纳评分评估，手工缝合IPAA（P = 0.01）、年龄较大（P = 0.03）、高体重指数（P = 0.04）以及手术指征（癌症/发育异常；P = 0.03）与排便障碍显著相关。多变量分析显示，手工缝合IPAA是独立危险因素（P = 0.049；比值比：4.99；95%置信区间：1.0 - 28.39）。我们发现，手工缝合IPAA是UC患者腹腔镜辅助RPC术后排便障碍的危险因素。
