Department of Surgery, Amsterdam UMC, Location AMC, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
Department of Gastroenterology, Amsterdam UMC, Location AMC, Amsterdam, The Netherlands.
Tech Coloproctol. 2023 Apr;27(4):297-307. doi: 10.1007/s10151-022-02713-x. Epub 2022 Nov 6.
During ileal pouch-anal anastomosis (IPAA) surgery for ulcerative colitis (UC), rectal dissection can be performed via close rectal dissection (CRD) or in a total mesorectal excision plane (TME). Although CRD should protect autonomic nerve function, this technique may be more challenging than TME. The aim of this study was to compare long-term outcomes of patients undergoing CRD and TME.
This single-centre retrospective cohort study included consecutive patients who underwent IPAA surgery for UC between January 2002 and October 2017. Primary outcomes were chronic pouch failure (PF) among patients who underwent CRD and TME and the association between CRD and developing chronic PF. Chronic PF was defined as a pouch-related complication occurring ≥ 3 months after primary IPAA surgery requiring redo pouch surgery, pouch excision or permanent defunctioning ileostomy. Secondary outcomes were risk factors and causes for chronic PF. Pouch function and quality of life were assessed via the Pouch dysfunction score and Cleveland global quality of life score.
Out of 289 patients (155 males, median age 37 years [interquartile range 26.5-45.5 years]), 128 underwent CRD. There was a shorter median postoperative follow-up for CRD patients than for TME patients (3.7 vs 10.9 years, p < 0.01). Chronic PF occurred in 6 (4.7%) CRD patients and 20 (12.4%) TME patients. The failure-free pouch survival rate 3 years after IPAA surgery was comparable among CRD and TME patients (96.1% vs. 93.5%, p = 0.5). CRD was a no predictor for developing chronic PF on univariate analyses (HR 0.7 CI-95 0.3-2.0, p = 0.54). A lower proportion of CRD patients developed chronic PF due to a septic cause (1% vs 6%, p = 0.03).
Although differences in chronic PF among CRD and TME patients were not observed, a trend toward TME patients developing chronic pelvic sepsis was detected. Surgeons may consider performing CRD during IPAA surgery for UC.
在溃疡性结肠炎（UC）的回肠袋肛管吻合术（IPAA）中，直肠分离可以通过紧贴直肠分离（CRD）或在全直肠系膜切除平面（TME）进行。虽然 CRD 应该保护自主神经功能，但该技术可能比 TME 更具挑战性。本研究旨在比较接受 CRD 和 TME 的患者的长期结果。
这是一项单中心回顾性队列研究，纳入了 2002 年 1 月至 2017 年 10 月期间接受 IPAA 手术治疗 UC 的连续患者。主要结局是接受 CRD 和 TME 的患者中慢性袋失败（PF）的发生率，以及 CRD 与慢性 PF 发生的关系。慢性 PF 定义为原发性 IPAA 手术后≥3 个月发生的与袋相关的并发症，需要进行再次袋手术、袋切除或永久性结肠造口术。次要结局是慢性 PF 的危险因素和原因。通过袋功能障碍评分和克利夫兰全球生活质量评分评估袋功能和生活质量。
在 289 名患者（155 名男性，中位年龄 37 岁[四分位距 26.5-45.5 岁]）中，128 名患者接受了 CRD。CRD 患者的中位术后随访时间短于 TME 患者（3.7 年比 10.9 年，p<0.01）。6 名（4.7%）CRD 患者和 20 名（12.4%）TME 患者发生慢性 PF。IPAA 手术后 3 年时，接受 CRD 和 TME 的患者的无失败袋存活率相当（96.1%比 93.5%，p=0.5）。在单因素分析中，CRD 不是发生慢性 PF 的预测因素（HR 0.7，95%CI-95% 0.3-2.0，p=0.54）。CRD 患者发生慢性袋感染的比例较低（1%比 6%，p=0.03）。
尽管在接受 CRD 和 TME 的患者中未观察到慢性 PF 存在差异，但发现 TME 患者发生慢性盆腔感染的趋势。外科医生在进行 UC 的 IPAA 手术时可能会考虑行 CRD。
