直式回肠肛管吻合术转为回肠贮袋肛管吻合术的长期疗效。
Long-term Outcomes of Straight Ileoanal Anastomoses Converted to Ileal Pouch Anal Anastomoses.
机构信息
Department of Colon & Rectal Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic Foundation, Cleveland, OH, USA.
Department of Pediatric Surgery, Cleveland Clinic Foundation, Cleveland, OH, USA.
出版信息
J Pediatr Surg. 2023 Oct;58(10):1898-1902. doi: 10.1016/j.jpedsurg.2023.03.001. Epub 2023 Mar 11.
BACKGROUND
While ileal pouch anal anastomosis (IPAA) is the recommended way to restore intestinal continuity after total proctocolectomy, straight ileoanal anastomoses (SIAA) are still selectively performed, especially in the pediatric population. In case of SIAA failure, conversion to IPAA is possible, but reports on its outcomes are scarce.
METHODS
We retrospectively analyzed our prospectively collected database on pelvic pouches, and identified patients with a SIAA that was converted to IPAA. Our aim was long-term functional outcomes.
RESULTS
Twenty-three patients were included (14 females, median age at SIAA 15 years, median age at conversion to IPAA 19 years). The indication for SIAA was ulcerative colitis in 17 (74%) cases, indeterminate colitis in 2 (9%) cases, and familial adenomatous polyposis in 4 (17%) cases. The indication for IPAA conversion was incontinence/poor quality of life in 12 (52%) cases, sepsis in 8 (35%) cases, anastomotic stricture in 2 (9%) cases, and prolapse in one (4%) case. The majority were diverted at IPAA conversion (22, 96%). Three (13%) patients never had stoma closure, due to patient wishes, failed healing of vaginal fistula, and pelvic sepsis, respectively. After a median follow up of 109 months (28-170), pouch failure occurred in 5 additional patients. Overall pouch survival was 71% at 5 years. Median quality of life was 8/10, of health 8/10, and of energy 7/10. Median satisfaction with surgery was 9.5/10.
CONCLUSION
Conversion of SIAA to IPAA leads to acceptable long-term outcomes and good quality of life, and can safely be offered to patients with problems related to SIAA.
LEVEL OF EVIDENCE
IV.
背景
虽然回肠贮袋肛管吻合术（IPAA）是全直肠结肠切除术后恢复肠道连续性的推荐方法，但直式回肠肛管吻合术（SIAA）仍被选择性施行，特别是在儿科人群中。如果 SIAA 失败，可以转换为 IPAA，但关于其结果的报告很少。
方法
我们回顾性分析了我们前瞻性收集的盆腔贮袋数据库，并确定了行 SIAA 转换为 IPAA 的患者。我们的目的是评估长期功能结果。
结果
共纳入 23 例患者（14 例女性，SIAA 时的中位年龄为 15 岁，转换为 IPAA 时的中位年龄为 19 岁）。SIAA 的适应证为溃疡性结肠炎 17 例（74%），不确定结肠炎 2 例（9%），家族性腺瘤性息肉病 4 例（17%）。IPAA 转换的适应证为失禁/生活质量差 12 例（52%），感染性休克 8 例（35%），吻合口狭窄 2 例（9%），脱垂 1 例（4%）。大多数患者在 IPAA 转换时进行了转流（22 例，96%）。由于患者意愿、阴道瘘愈合失败和骨盆感染，3 例（13%）患者从未进行过造口关闭。中位随访 109 个月（28-170）后，又有 5 例患者出现贮袋失败。5 年时贮袋总存活率为 71%。生活质量中位数为 8/10，健康状况中位数为 8/10，精力状况中位数为 7/10。手术满意度中位数为 9.5/10。
结论
SIAA 转换为 IPAA 可获得可接受的长期结果和良好的生活质量，可安全地提供给与 SIAA 相关问题的患者。
证据等级
IV。
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