Imperial College London, London, UK.
Surrey and Sussex Healthcare NHS Trust, Redhill, UK.
Int J Colorectal Dis. 2022 Feb;37(2):357-364. doi: 10.1007/s00384-021-04067-6. Epub 2021 Nov 26.
The ileoanal pouch (IPAA) provides patients with ulcerative colitis (UC) that have not responded to medical therapy an option to retain bowel continuity and defecate without the need for a long-term stoma. Despite good functional outcomes, some pouches fail, requiring permanent diversion, pouchectomy, or a redo pouch. The incidence of pouch failure ranges between 2 and 15% in the literature. We conducted a systematic review and meta-analysis aiming to define the prevalence of pouch failure in patients with UC who have undergone IPAA using population-based studies.
We searched Embase, Embase classic and PubMed from 1978 to 31st of May 2021 to identify cross-sectional studies that reported the prevalence of pouch failure in adults (≥ 18 years of age) who underwent IPAA for UC.
Twenty-six studies comprising 23,389 patients were analysed. With < 5 years of follow-up, the prevalence of pouch failure was 5% (95%CI 3-10%). With ≥ 5 but < 10 years of follow-up, the prevalence was 5% (95%CI 4-7%). This increased to 9% (95%CI 7-16%) with ≥ 10 years of follow-up. The overall prevalence of pouch failure was 6% (95%CI 5-8%).
The overall prevalence of pouch failure in patients over the age of 18 who have undergone restorative proctocolectomy in UC is 6%. These data are important for counselling patients considering this operation. Importantly, for those patients with UC being considered for a pouch, their disease course has often resulted in both physical and psychological morbidity and hence providing accurate expectations for these patients is vital.
对于那些对药物治疗没有反应的溃疡性结肠炎（UC）患者，回肠贮袋肛管吻合术（IPAA）为他们提供了一种保留肠道连续性并无需长期造口即可排便的选择。尽管该手术具有良好的功能效果，但有些贮袋会出现失败，需要永久性转流、贮袋切除术或重新进行贮袋手术。文献中贮袋失败的发生率在 2%至 15%之间。我们进行了一项系统评价和荟萃分析，旨在通过基于人群的研究定义接受 IPAA 的 UC 患者贮袋失败的发生率。
我们从 1978 年至 2021 年 5 月 31 日，在 Embase、Embase classic 和 PubMed 中搜索了报告成人（≥18 岁）接受 IPAA 治疗 UC 后贮袋失败发生率的横断面研究。
分析了 26 项研究，共纳入 23389 例患者。随访时间<5 年时，贮袋失败的发生率为 5%（95%CI 3-10%）；随访时间≥5 年但<10 年时，发生率为 5%（95%CI 4-7%）；随访时间≥10 年时，发生率增加至 9%（95%CI 7-16%）。总体贮袋失败的发生率为 6%（95%CI 5-8%）。
在年龄大于 18 岁的接受 UC 直肠结肠切除术的患者中，贮袋失败的总体发生率为 6%。这些数据对考虑接受该手术的患者进行咨询很重要。重要的是，对于那些正在考虑接受贮袋手术的 UC 患者，他们的疾病过程已经导致了身体和心理上的发病率，因此为这些患者提供准确的预期是至关重要的。
