Matsuda Keiji, Hashiguchi Yojiro, Hayama Tamuro, Hayashi Kurara, Miyata Toshiya, Asako Kentaro, Fukushima Yoshihisa, Shimada Ryu, Kaneko Kensuke, Nozawa Keijiro, Ochiai Hiroki, Yamamoto Takatsugu
Department of Surgery, Teikyo University School of Medicine, Tokyo, Japan.
Department of Medicine, Teikyo University School of Medicine, Tokyo, Japan.
Inflamm Intest Dis. 2024 Feb 26;9(1):55-61. doi: 10.1159/000538025. eCollection 2024 Jan-Dec.
Restorative proctocolectomy with ileal pouch-anal anastomosis (IPAA) is the surgical procedure for ulcerative colitis (UC). Intestinal ischemia may occur if the main blood vessels are ligated at an early stage of this surgery. Considering that the blood flow in the large intestine can be maintained by preserving the middle colic artery, we have used a new IPAA method: ligating the middle colic artery immediately before removal of the specimens ("M-method"). Here, we evaluated the M-method's clinical outcomes.
Between April 2009 and December 2021, 13 patients underwent a laparoscopy-assisted IPAA procedure at our institution. The conventional method was used for 6 patients, and the M-method was used for the other 7 patients. We retrospectively analyzed the cases' clinical notes.
The M-method's rate of postoperative complications (Clavien-Dindo classification grade II or more) was significantly lower than that of the conventional method (14.2% vs. 83.3%). The M-method group's postoperative stay period was also significantly shorter (average 16.4 days vs. 55.5). There were significant differences in the albumin value and the ratio of the modified GPS score 1 or 2 on the 7th postoperative day between the M- and conventional methods (average 3.15 vs. 2.5, average 4/7 vs. 6/6). However, it is necessary to consider the small number of cases and the uncontrolled historical comparison.
Late ligation of the middle colic artery may be beneficial for patients' post-surgery recovery and can be recommended for IPAAs in UC patients.
回肠储袋肛管吻合术（IPAA）的结直肠修复术是治疗溃疡性结肠炎（UC）的外科手术。如果在此手术的早期阶段结扎主要血管，可能会发生肠道缺血。考虑到保留结肠中动脉可维持大肠的血流，我们采用了一种新的IPAA方法：在切除标本前立即结扎结肠中动脉（“M法”）。在此，我们评估了M法的临床疗效。
2009年4月至2021年12月，13例患者在我院接受了腹腔镜辅助IPAA手术。6例患者采用传统方法，另外7例患者采用M法。我们回顾性分析了这些病例的临床记录。
M法的术后并发症发生率（Clavien-Dindo分级II级或更高）显著低于传统方法（14.2%对83.3%）。M法组的术后住院时间也显著缩短（平均16.4天对55.5天）。M法与传统方法在术后第7天的白蛋白值和改良GPS评分1或2的比例方面存在显著差异（平均3.15对2.5，平均4/7对6/6）。然而，有必要考虑病例数量少和非对照历史比较的因素。
结肠中动脉的延迟结扎可能有利于患者术后恢复，可推荐用于UC患者的IPAA手术。
