Keighley M R
Dis Colon Rectum. 1987 May;30(5):386-90. doi: 10.1007/BF02555460.
Thirty-two ileoanal J-pouch procedures have been performed by the author between 1983 and 1986. Two pouches have been excised, one has been defunctioned for diarrhea, and seven patients either have not had their ileostomy closed or have not been followed for more than four months after restoration of intestinal continuity. Of the remaining 22 patients, 12 early operations involved endoanal mucosectomy while in the ten most recent procedures, the rectum and anal mucosa have been excised from the abdomen. Incidence of complications between the methods of mucosal excision were comparable apart from cuff abscess (n = 5) which only occur after endoanal muscosectomy. Functional results were identical apart from the incidence of soiling which occurred in six of 12 patients after endoanal mucosectomy but in only one of ten patients after abdominal mucosectomy. Resting anal canal pressures fell significantly after endoanal mucosectomy (87 to 60cm H20, P less than 0.05) but not after abdominal mucosectomy (82 to 81 cm H20). These differences may be due to the duration and extent of anal retraction, which was 72 minutes after endoanal mucosectomy but only 18 minutes after abdominal mucosectomy. Abdominal mucosectomy appears to cause less sphincter damage and soiling than conventional endoanal excision.
1983年至1986年间，作者共实施了32例回肠肛管J形储袋手术。其中2例储袋已被切除，1例因腹泻而使其失去功能，7例患者未关闭回肠造口或在肠道连续性恢复后未接受超过4个月的随访。在其余22例患者中，12例早期手术采用经肛门黏膜切除术，而在最近的10例手术中，直肠和肛管黏膜是经腹部切除的。除了袖带脓肿（n = 5）仅发生在经肛门黏膜切除术后外，两种黏膜切除方法的并发症发生率相当。除了便污发生率不同外，功能结果相同，经肛门黏膜切除术后12例患者中有6例出现便污，而经腹部黏膜切除术后10例患者中只有1例出现便污。经肛门黏膜切除术后静息肛管压力显著下降（从87降至60cm H₂O，P < 0.05），而经腹部黏膜切除术后则未下降（从82降至81cm H₂O）。这些差异可能是由于肛门牵开的持续时间和范围不同，经肛门黏膜切除术后为72分钟，而经腹部黏膜切除术后仅为18分钟。与传统的经肛门切除术相比，经腹部黏膜切除术似乎对括约肌的损伤和便污较少。
