Fonkalsrud E W, Ament M E, Byrne W J
Gastroenterology. 1979 Jul;77(1):156-60.
During the past 3 yr, 17 patients with chronic ulcerative colitis and 6 with Crohn's disease who had severe rectal and colonic involvement underwent excision of the rectal mucosa without removal of the rectal muscle in combination with total colectomy and cutaneous ileostomy as a 1- or 2-stage procedure. This operative technique has cured each of the patients of their primary colonic and rectal disease and has obviated many of the unpleasant complications that often occur after total proctectomy, such as impotence, prolonged perineal drainage, and bladder dysfunction. The operation has the further advantages of lower operative blood loss, shorter operative time, and earlier safe ambulation. On the basis of the favorable experience with mucosal proctectomy, sphincterotomy, and perineal drainage in 23 patients, none of whom experienced major complications, we believe that this operation warrants further clinical trial in patients with inflammatory bowel disease involving the rectum, which is refractory to medical therapy. Total proctectomy might eventually find scant application in patients with inflammatory bowel disease.
在过去3年中，17例慢性溃疡性结肠炎患者和6例克罗恩病患者，其直肠和结肠严重受累，接受了保留直肠肌层的直肠黏膜切除术，并联合全结肠切除术和经腹会阴皮肤造口术，分1期或2期进行。这种手术技术已治愈了每位患者的原发性结肠和直肠疾病，避免了全直肠切除术后常出现的许多不良并发症，如阳痿、会阴引流时间延长和膀胱功能障碍。该手术还具有术中失血量少、手术时间短和能更早安全下床活动的优点。基于23例患者行黏膜直肠切除术、括约肌切开术和会阴引流术的良好经验（这些患者均未出现严重并发症），我们认为该手术值得在药物治疗无效的炎症性肠病累及直肠的患者中进行进一步临床试验。全直肠切除术最终可能在炎症性肠病患者中的应用有限。
