Ziv Y, Church J M, Oakley J R, McGannon E, Fazio V W
Department of Colorectal Surgery, Cleveland Clinic Foundation, OH 44195, USA.
Int J Colorectal Dis. 1995;10(1):6-9. doi: 10.1007/BF00337577.
Increasing numbers of polyposis registries have led to more young patients being diagnosed with familial adenomatous polyposis (FAP). To provide guidelines for selecting the appropriate surgical procedure in teenagers (10-19 years), we compared the results of colectomy and ileo-rectal anastomosis (IRA, n = 17 patients) to the results of restorative proctocolectomy and ileal pouch-anal anastomosis (IPAA, n = 7 patients). Charts were reviewed to obtain data on the operative technique, blood loss and transfusions, hospital stay (including the time for ileostomy closure), and early (within 30 days of surgery) and late complications. Functional results (bowel movements per 24 h, use of antidiarrheal drugs, seepage, and fecal incontinence) and quality of life were evaluated prospectively with a questionnaire and physical examination. The median follow-up time was 49 months (range, 6 to 95 months) after IRA, and 36 months after IPAA (range, 4 to 87 months). Although restorative proctocolectomy and IPAA, is a longer (5.75 vs 3.1 hours), more bloody (500 vs 300 mL blood loss), and more complex operation with a longer hospital stay (12 vs 7 days) than IRA (P = 0.008, P = 0.006, P = 0.02, respectively), no significant difference (P > 0.05) was found between groups concerning the complication rate or quality of life. For teenagers with FAP and rectal carpeting, large rectal adenomas, curable cancer in the upper two-thirds of the rectum, or who are unavailable for follow-up, we recommend a restorative proctocolectomy and IPAA. For the other patients, the decision whether to perform IRA or restorative proctocolectomy with IPAA depends on the patient's desire and the surgeon's skill.
越来越多的息肉病登记机构使得更多年轻患者被诊断为家族性腺瘤性息肉病（FAP）。为了为青少年（10至19岁）选择合适的手术方式提供指导，我们将结肠切除术和回肠直肠吻合术（IRA，17例患者）的结果与全直肠系膜切除回肠储袋肛管吻合术（IPAA，7例患者）的结果进行了比较。查阅病历以获取手术技术、失血量和输血情况、住院时间（包括回肠造口关闭时间）以及早期（术后30天内）和晚期并发症的数据。通过问卷调查和体格检查对功能结果（每24小时排便次数、止泻药使用情况、渗漏和大便失禁）和生活质量进行前瞻性评估。IRA术后中位随访时间为49个月（范围6至95个月），IPAA术后为36个月（范围4至87个月）。尽管全直肠系膜切除回肠储袋肛管吻合术比IRA手术时间更长（5.75小时对3.1小时）、失血量更多（500毫升对300毫升）、操作更复杂且住院时间更长（12天对7天）（分别为P = 0.008、P = 0.006、P = 0.02），但两组在并发症发生率或生活质量方面未发现显著差异（P>0.05）。对于患有FAP且直肠布满息肉、直肠大腺瘤、直肠上三分之二可治愈癌症或无法进行随访的青少年，我们建议行全直肠系膜切除回肠储袋肛管吻合术。对于其他患者，决定是进行IRA还是全直肠系膜切除回肠储袋肛管吻合术取决于患者的意愿和外科医生的技术水平。
