Fazio V W, Ziv Y, Church J M, Oakley J R, Lavery I C, Milsom J W, Schroeder T K
Department of Colorectal Surgery, Cleveland Clinic Foundation, OH 44195, USA.
Ann Surg. 1995 Aug;222(2):120-7. doi: 10.1097/00000658-199508000-00003.
Restorative proctocolectomy and ileal pouch-anal anastomosis (IPAA) has become an established surgery for patients with chronic ulcerative colitis and familial adenomatous polyposis.
The authors report the results of an 11-year experience of restorative proctocolectomy and IPAA at a tertiary referral center.
Chart review was performed for 1005 patients undergoing IPAA from 1983 through 1993. Preoperative histopathologic diagnoses were ulcerative colitis (n = 858), familial adenomatous polyposis (n = 62), indeterminate colitis (n = 75), and miscellaneous (n = 10). Information was obtained regarding patient demographics, type and duration of diseases, previous operations, and indications for surgery. Data were collected on surgical procedure and postoperative pathologic diagnosis. Early (within 30 days after surgery) and late complications were noted. Follow-up included an annual function and quality-of-life questionnaire, physical examination, and biopsies of the pouch and anal transitional zone.
Of the 1005 patients (455 women), postoperative histopathologic diagnoses were as follows: ulcerative colitis (n = 812), familial adenomatous polyposis (n = 62), indeterminate colitis (n = 54), Crohn's disease (n = 67), and miscellaneous (n = 10). During a mean follow-up time of 35 months (range 1-125 months), histopathologic diagnoses were changed for 25 patients. The overall mortality rate was 1% (n = 10 patients, early = 4, late = 6); one death (0.1%) was related to pouch necrosis and sepsis. The overall morbidity rate was 62.7% (1218 complications in 630 patients; early, n = 27.5%; late, n = 50.5%). Septic complication and reoperation rates were 6.8% and 24%, respectively. The ileal pouch was removed in 34 patients (3.4%), and it is nonfunctional in 11 (1%). Functional results and quality of life were good to excellent in 93% of the patients with complete data (n = 645) and are similar for patients with ulcerative colitis, familial adenomatous polyposis, indeterminate colitis, and Crohn's disease. Patients who underwent operations from 1983 through 1988 have similar functional results and quality of life compared with patients who underwent operations after 1988.
Restorative proctocolectomy with an IPAA is a safe procedure, with low mortality and major morbidity rates. Although total morbidity rate is appreciable, functional results generally are good and patient satisfaction is high.
保留性直肠结肠切除术及回肠储袋肛管吻合术（IPAA）已成为治疗慢性溃疡性结肠炎和家族性腺瘤性息肉病患者的常用手术。
作者报告了在一家三级转诊中心进行保留性直肠结肠切除术及IPAA的11年经验结果。
对1983年至1993年间接受IPAA的1005例患者进行病历回顾。术前组织病理学诊断为溃疡性结肠炎（n = 858）、家族性腺瘤性息肉病（n = 62）、不确定性结肠炎（n = 75）和其他（n = 10）。获取了有关患者人口统计学、疾病类型和病程、既往手术及手术指征的信息。收集了手术操作及术后病理诊断的数据。记录早期（术后30天内）和晚期并发症。随访包括每年的功能和生活质量问卷调查、体格检查以及储袋和肛管移行区活检。
1005例患者（455例女性）中，术后组织病理学诊断如下：溃疡性结肠炎（n = 812）、家族性腺瘤性息肉病（n = 62）、不确定性结肠炎（n = 54）、克罗恩病（n = 67）和其他（n = 10）。在平均35个月（范围1 - 125个月）的随访时间内，25例患者的组织病理学诊断发生了改变。总死亡率为1%（n = 10例患者，早期 = 4例，晚期 = 6例）；1例死亡（0.1%）与储袋坏死和脓毒症有关。总发病率为62.7%（630例患者出现1218例并发症；早期，n = 27.5%；晚期，n = 50.5%）。感染性并发症和再次手术率分别为6.8%和24%。34例患者（3.4%）的回肠储袋被切除，11例（1%）无功能。在有完整数据的93%的患者（n = 645）中，功能结果和生活质量良好至优秀，溃疡性结肠炎、家族性腺瘤性息肉病、不确定性结肠炎和克罗恩病患者的情况相似。1983年至1988年接受手术的患者与1988年后接受手术的患者在功能结果和生活质量方面相似。
保留性直肠结肠切除术及IPAA是一种安全的手术，死亡率和主要发病率较低。尽管总发病率较高，但功能结果通常良好，患者满意度较高。
