Global Center for Integrated Colorectal Surgery and IBD Interventional Endoscopy, Columbia University Medical Center, New York, New York.
Dis Colon Rectum. 2024 Jun 1;67(S1):S36-S45. doi: 10.1097/DCR.0000000000003332. Epub 2024 Mar 9.
The IPAA is a boon to patients needing proctocolectomy but maintains per anal function through anatomic and physiologic compromises. The state of pouch function is hard to define because pouch anatomy is not normal and pouch physiology is a distortion of normal defecation. Patients with pouches develop multiple symptoms: some are expected, some are disease related, and some are the result of surgical complications. It is important to understand the cause of pouch-related symptoms so that appropriate management is offered.
The study aimed to review pouch symptoms and discuss their likely cause, review the literature on pouch function and dysfunction, and provide clarity to clear the confusion.
PubMed and Cochrane databases were searched using the terms "ileoanal pouch function" and "ileoanal pouch dysfunction."
From 1983 to 2023, 553 articles related to "ileoanal pouch function" and 178 related to "ileoanal pouch dysfunction" were reviewed. Nine studies appeared under both headings. Case studies, duplicate publications, and articles concerning pouch diseases were excluded.
Definitions of pouch function and dysfunction, methods of describing and scoring symptoms, and understanding of expected changes in pouch function given the nature of the surgery.
Twenty-seven studies were reviewed from the ileoanal pouch dysfunction search and 38 from ileoanal pouch function. Three studies tried to define normal pouch function, 10 attempted to measure pouch function, and 4 aimed to score pouch function. Only 3 studies addressed pouch physiology.
A full discussion of pouch dysfunction is limited by the lack of studies focussing on the anatomic and physiologic consequences of turning the terminal ileum into an organ of storage.
Most studies of pouch function and dysfunction do not consider expected changes in the physiology of defecation that follow restorative proctocolectomy. Thus, most studies of pouch function produce conclusions that lack an important dimension. See video from symposium.
IPAA 对于需要进行结肠直肠切除术的患者来说是一种福音，但它通过解剖学和生理学上的妥协来维持经肛门功能。袋状功能的状态很难定义，因为袋状解剖结构不正常，袋状生理学是正常排便的扭曲。患有袋状的患者会出现多种症状：有些是预期的，有些是与疾病相关的，有些是手术并发症的结果。了解袋状相关症状的原因很重要，以便提供适当的治疗。
本研究旨在回顾袋状症状并讨论其可能的原因，回顾关于袋状功能和功能障碍的文献，并提供清晰的认识以消除混淆。
使用“回肠肛管袋功能”和“回肠肛管袋功能障碍”术语在 PubMed 和 Cochrane 数据库中进行搜索。
从 1983 年到 2023 年，共回顾了 553 篇与“回肠肛管袋功能”相关的文章和 178 篇与“回肠肛管袋功能障碍”相关的文章。有 9 项研究同时出现在这两个标题下。排除了病例研究、重复发表的文章和涉及袋状疾病的文章。
袋状功能和功能障碍的定义、描述和评分症状的方法，以及考虑到手术性质对袋状功能预期变化的理解。
从回肠肛管袋功能障碍搜索中回顾了 27 项研究，从回肠肛管袋功能中回顾了 38 项研究。有 3 项研究试图定义正常的袋状功能，有 10 项研究试图测量袋状功能，有 4 项研究旨在对袋状功能进行评分。只有 3 项研究涉及袋状生理学。
对将末端回肠转变为储存器官的解剖学和生理学后果进行全面讨论的袋状功能障碍研究受到限制。
大多数关于袋状功能和功能障碍的研究都没有考虑到直肠结肠切除术后排便生理学的预期变化。因此，大多数关于袋状功能的研究得出的结论缺乏一个重要的维度。请观看研讨会的视频。
