Sitzmann J V, Burns R C, Bayless T M
Department of Surgery, Johns Hopkins Hospital, Baltimore, MD 21287-4665, USA.
Surgery. 1995 Nov;118(5):797-802. doi: 10.1016/s0039-6060(05)80267-3.
The ileal anal pull-through procedure has become the most frequently used cointinence sparing procedure for patients with ulcerative colitis or familial polyposis. Areas of controversy concern the use of temporary ileostomies, and the extent of the rectal mucosectomy. The current report presents a single surgeon's experience with mucosectomy to the perianal skin (squamous mucosectomy), with ileal J-pouch reservoir construction and temporary ileostomy.
We reviewed the records of 105 consecutive patients undergoing this procedure by a single surgeon during a 5-year period. One hundred percent follow-up was achieved.
There was 100% gross fecal continence, with 5% of patients expressing rare day time leakage, and 28% having intermittent nocturnal leakage. There were no instances of pelvic sepsis, and no pouches have been removed. The diverting ileostomy was associated with 6% morbidity.
We conclude that the rectal mucosectomy can be safely extended to the levels of perianal skin with no loss in continence or function. We recommend that this be adopted as the standard for this procedure to ensure complete eradication of the underlying pathologic condition.
回肠肛管拖出术已成为溃疡性结肠炎或家族性息肉病患者最常用的保留控便功能的手术。存在争议的方面包括临时回肠造口术的使用以及直肠黏膜切除术的范围。本报告介绍了一位外科医生在进行直肠黏膜切除至肛周皮肤（鳞状黏膜切除术）、构建回肠J袋贮袋及临时回肠造口术方面的经验。
我们回顾了一位外科医生在5年期间连续进行该手术的105例患者的记录。随访率达100%。
大便完全自控率为100%，5%的患者表示白天偶尔有渗漏，28%的患者夜间有间歇性渗漏。无盆腔感染病例，且无贮袋被切除。转流性回肠造口术的并发症发生率为6%。
我们得出结论，直肠黏膜切除术可安全地扩展至肛周皮肤水平，控便功能或功能无损失。我们建议将此作为该手术的标准，以确保彻底根除潜在的病理状况。
