Department of General Surgery, Guiping People's Hospital, No.7, People's West Road, Guiping, Guigang, 537200, Guangxi Autonomous Region, China.
Department of Gastrointestinal Surgery, Division of Colorectal and Anal, Guangxi Medical University Cancer Hospital, No.71, Hedi Road, Qingxiu District, Nanning, 530021, Guangxi Autonomous Region, China.
World J Surg Oncol. 2022 Jan 22;20(1):20. doi: 10.1186/s12957-022-02488-3.
To achieve excellent postoperative bowel function in familial adenomatous polyposis (FAP) patients, it is important to reconstruct the digestive tract. The aim of this study is to preliminarily discuss the advantages of total proctocolectomy with straight ileoanal anastomosis (TPC-SIAA) plus pedicled omental transposition for FAP.
A retrospective study was carried out in two hospitals analysing data for FAP patients who underwent surgical treatments between 2015 and 2021. Perioperative outcomes and early and mid-term anal functions were analysed.
After excluding 4 patients who underwent total proctocolectomy with permanent ileostomy, 10 patients were enrolled in the study. Among the 10 patients, 3 received TPC-SIAA plus pedicled omental transposition, 3 received total proctocolectomy with ileal pouch-anal anastomosis (TPC-IPAA), and 4 received total colectomy with ileal pouch-rectal anastomosis (TC-IPRA). Except for one case conversion to laparotomy, laparoscopic surgery was performed for the other cases. The incidence of early postoperative complications was apparently higher with pouch anastomosis (57.1%) than straight anastomosis (0%). Frequencies of bowel movement and low anterior resection syndrome (LARS) score were higher for TPC-SIAA than the other two surgical procedures in the early term; over time, however, the frequencies of bowel movement and LARS score both showed a decreasing trend. In addition, combined with anorectal pressure detection and magnetic resonance imaging defecography at the 3rd month after TPC-SIAA plus pedicled omental transposition, defecation coordination was good. The dynamics and receptivity of the new rectum tended to be as expected.
Although the three surgical procedures are safe and feasible surgical options for FAP, TPC-SIAA plus pedicled omental transposition is more consistent with intestinal physiology, with good intestinal compliance, and anal function tended to be as expected over time. Nevertheless, more extensive studies are needed to confirm these benefits.
为了使家族性腺瘤性息肉病（FAP）患者获得良好的术后肠道功能，重建消化道非常重要。本研究旨在初步探讨全直肠结肠切除加直乙结肠吻合术（TPC-SIAA）加带蒂大网膜转位治疗 FAP 的优势。
对 2015 年至 2021 年间在两家医院接受手术治疗的 FAP 患者进行回顾性研究，分析围手术期结果和早期及中期肛门功能。
排除 4 例永久性回肠造口的全直肠结肠切除术后患者后，10 例患者纳入本研究。其中 3 例接受 TPC-SIAA 加带蒂大网膜转位，3 例接受全直肠结肠切除加回肠袋肛管吻合术（TPC-IPAA），4 例接受全结肠切除加回肠袋直肠吻合术（TC-IPRA）。除 1 例中转开腹外，其余病例均行腹腔镜手术。吻合口（57.1%）的早期术后并发症发生率明显高于吻合口（0%）。TPC-SIAA 的排便频率和低位前切除综合征（LARS）评分在早期均高于其他两种手术；但随着时间的推移，排便频率和 LARS 评分均呈下降趋势。此外，在 TPC-SIAA 加带蒂大网膜转位术后 3 个月结合肛肠压力检测和磁共振成像排粪造影，排便协调性良好。新直肠的动力学和感觉度趋于预期。
虽然三种手术方法均为 FAP 安全可行的手术选择，但 TPC-SIAA 加带蒂大网膜转位更符合肠道生理，肠顺应性好，且随着时间的推移，肛门功能趋于预期。然而，还需要更广泛的研究来证实这些益处。
