Department for Colorectal Surgery, Digestive Disease Institute, Cleveland Clinic Main Campus, 9500 Euclid Ave, A30, Cleveland, OH, 44122, USA.
Langenbecks Arch Surg. 2024 Oct 15;409(1):308. doi: 10.1007/s00423-024-03498-3.
Patients with multiple sclerosis and Parkinson's disease may experience pelvic floor dysfunction and constipation which can affect ileoanal pouch emptying. This can lead to complications such as pouchitis, pouch dysfunction, and failure. We hypothesized that patients with neurological diseases have a higher rate of pouch failure and complications than healthy controls.
Data were sourced from the institutional ileoanal pouch database. Patients with multiple sclerosis or Parkinson's disease, diagnosed before or after pouch construction, were matched to a control group of patients without neurological disease using propensity score-optimal matching. Demographics, postoperative and functional outcomes, and quality of life were analyzed.
Twenty-six patients (38%) with multiple sclerosis and 16 (62%) with Parkinson's disease were matched with 42 healthy controls. The overall median age was 39 years, median BMI was 25.3 kg/m, and most patients were female (61.9%). Preoperative colorectal diagnoses included ulcerative colitis (83.3%), indeterminate colitis (9.5%), and Crohn's disease (7.1%). Patients with neurological diseases had higher ASA scores (class III, 57.1% vs. 21.4%; p < 0.01), fewer nocturnal bowel movements (median 0 vs. 2; p < 0.001), fewer bowel movements over 24 h (median 6 vs. 8; p = 0.01), and were less likely to recommend IPAA construction (72.7% vs. 97%; p = 0.01) than the controls. Other surgical, functional, and quality-of-life outcomes were similar.
Patients with multiple sclerosis or Parkinson's disease might differ in pouch function compared with healthy controls. These neurological diseases might affect pouch function. The rate of pouch failure was similar, showing its feasibility despite multiple sclerosis and Parkinson's disease.
多发性硬化症和帕金森病患者可能会出现盆底功能障碍和便秘，这可能会影响回肠贮袋排空。这可能会导致 pouchitis、贮袋功能障碍和贮袋失败等并发症。我们假设患有神经疾病的患者比健康对照组具有更高的贮袋失败和并发症发生率。
数据来源于机构回肠贮袋数据库。将术前或术后诊断为多发性硬化症或帕金森病的患者与无神经疾病的对照组患者进行倾向评分最佳匹配。分析患者的人口统计学、术后和功能结果以及生活质量。
26 例（38%）多发性硬化症患者和 16 例（62%）帕金森病患者与 42 例健康对照组相匹配。患者的总体中位年龄为 39 岁，中位 BMI 为 25.3kg/m2，大多数为女性（61.9%）。术前结直肠诊断包括溃疡性结肠炎（83.3%）、不确定结肠炎（9.5%）和克罗恩病（7.1%）。神经疾病患者的 ASA 评分更高（III 级，57.1% vs. 21.4%；p<0.01），夜间排便次数更少（中位数 0 次 vs. 2 次；p<0.001），24 小时内排便次数更少（中位数 6 次 vs. 8 次；p=0.01），且不太推荐回肠贮袋肛管吻合术（72.7% vs. 97%；p=0.01）。其他手术、功能和生活质量结果相似。
与健康对照组相比，多发性硬化症或帕金森病患者的贮袋功能可能存在差异。这些神经疾病可能会影响贮袋功能。尽管患有多发性硬化症和帕金森病，贮袋失败率仍相似，表明其可行性。
