Buhr H J, Heuschen U A, Stern J, Herfarth C
Chirurgische Klinik, Ruprecht-Karls-Universität Heidelberg.
Zentralbl Chir. 1994;119(12):867-77.
Nowadays restorative proctocolectomy and ileal pouch-anal anastomosis represent the standard procedure in the treatment for ulcerative colitis and familial polyposis. Although various pouchdesigns are described, the J-pouch is the one most frequently used. This study reviewed 311 operations of restorative proctocolectomy and ileal pouch-anal anastomosis between January 82 and December 93. The indication was ulcerative colitis in 234 and familial polyposis in 77 cases. In 67% of the cases the standard two-stage procedure involving secondary ileostomy closure was chosen. Due to the complex nature of the operation, postoperative morbidity--which is higher for ulcerative colitis--must not be undermined. Complete exstirpation of the pouch was required in 4.2% of the patients with ulcerative colitis and in one case with familial polyposis. In 12.4% and 1.3% a severe pouchitis was found in ulcerative colitis and familial polyposis respectively. In general postoperative functional results were satisfactory. Continence was established in over 90% of the patients while the mean stool frequency was 6 per day.
如今,全结直肠切除回肠贮袋肛管吻合术是治疗溃疡性结肠炎和家族性息肉病的标准术式。尽管有多种贮袋设计,但J形贮袋是最常用的一种。本研究回顾了1982年1月至1993年12月期间311例全结直肠切除回肠贮袋肛管吻合术。其中234例的适应证为溃疡性结肠炎,77例为家族性息肉病。67%的病例选择了包括二期回肠造口关闭的标准两阶段手术。由于手术的复杂性,溃疡性结肠炎患者术后发病率较高这一点不容忽视。4.2%的溃疡性结肠炎患者和1例家族性息肉病患者需要完全切除贮袋。溃疡性结肠炎和家族性息肉病患者中分别有12.4%和1.3%出现严重的贮袋炎。总体而言,术后功能结果令人满意。超过90%的患者建立了控便能力,平均每日排便次数为6次。