Lavery I C, Sirimarco M T, Ziv Y, Fazio V W
Department of Colorectal Surgery, Cleveland Clinic Foundation, Ohio 44195, USA.
Dis Colon Rectum. 1995 Aug;38(8):803-6. doi: 10.1007/BF02049836.
One technique used during restorative proctocolectomy to prevent loss of continence involves preservation of the anal canal. This technique retains a small amount of colonic mucosa and transitional mucosa that may become inflamed or develop dysplastic or neoplastic changes.
This study was designed to determine the presence and severity of anal canal inflammation and the need for treatment.
Records of 217 patients with mucosal ulcerative colitis who underwent restorative proctocolectomy with a stapled ileal pouch-anal anastomosis without anal mucosectomy from 1987 through 1990 were retrospectively reviewed.
Anal canal inflammation was evident on both endoscopy and biopsy in 48 patients (22.11 percent); 18 patients (8.29 percent) had a normal ileal pouch (9 had symptoms; 5 required topical treatment), and 30 patients (13.82 percent) had associated ileal pouch inflammation (23 with symptoms requiring systemic treatment because of pouchitis; 10 patients had concomitant topical treatment).
Symptomatic inflammation of the retained mucosa occurred in 32 (14.7 percent) patients. Nine (4.1 percent) patients had inflammation of the anal canal alone, and 23 (10.6 percent) had pouchitis in addition. The need for treatment occurred in 28 (12.9 percent) of the total ((2.3 percent) patients with anal canal inflammation and 23 (10.6 percent) with anal canal inflammation plus pouchitis).
在恢复性直肠结肠切除术中用于防止大便失禁的一种技术涉及保留肛管。该技术保留少量可能会发炎或发生发育异常或肿瘤性改变的结肠黏膜和移行黏膜。
本研究旨在确定肛管炎症的存在和严重程度以及治疗需求。
回顾性分析了1987年至1990年期间217例行保留肛管黏膜的吻合器回肠袋肛管吻合术的黏膜溃疡性结肠炎患者的记录。
48例患者（22.11%）在内镜检查和活检中均显示肛管炎症；18例患者（8.29%）回肠袋正常（9例有症状；5例需要局部治疗），30例患者（13.82%）伴有回肠袋炎症（23例因袋炎有症状需要全身治疗；10例患者同时进行局部治疗）。
32例（14.7%）患者出现保留黏膜的症状性炎症。9例（4.1%）患者仅肛管有炎症，23例（10.6%）患者还伴有袋炎。28例（12.9%）患者（肛管炎症患者中的2.3%和肛管炎症加袋炎患者中的23例（10.6%））需要治疗。
