Deen K I, Hubscher S, Bain I, Patel R, Keighley M R
University Department of Surgery, Queen Elizabeth Hospital, Edgbaston, Birmingham, UK.
Br J Surg. 1994 Jun;81(6):900-3. doi: 10.1002/bjs.1800810636.
A non-randomized prospective study of 38 patients, 32 with ulcerative colitis and six with familial adenomatous polyposis (FAP), who underwent high or low anal transection during stapled restorative proctocolectomy was undertaken. The median (range) height of the staple line 6 months after operation was 5.2 (3.2-6.0) cm after high transection compared with 2.9 (1.8-3.6) cm after low transection. Nineteen of 20 patients after high anal transection had columnar epithelium in the distal 'doughnut' versus 16 of 18 after low transection. Active colitis was present in 12 of 19 'doughnuts' in patients with high anal transection and columnar mucosa and in seven of 16 after low transection. Nine patients (high transection two, low transection seven; P < 0.05) had striated muscle in the stapled distal 'doughnut'. Dysplasia was found in the resected colon in one patient with ulcerative colitis and adenocarcinoma in two colectomy specimens (ulcerative colitis, one; FAP, one). No dysplasia or carcinoma was seen in any of the 'doughnuts' from patients with ulcerative colitis. Four patients with FAP (high transection, two; low transection, two) had microadenoma in the distal 'doughnut'. Despite attempts to place a stapled pouch-anal anastomosis below the anal transition zone, it was not possible to remove columnar mucosa completely from the remaining anal canal in most patients (16 of 18). High anal transection and pouch-anal anastomosis should be the preferred option in restorative proctocolectomy, as a dentate-line anastomosis may not fully eliminate columnar epithelium and may involve resection of some of the external sphincter.
对38例患者进行了一项非随机前瞻性研究，其中32例为溃疡性结肠炎患者，6例为家族性腺瘤性息肉病（FAP）患者，这些患者在吻合器辅助的保留直肠结肠切除术期间接受了高位或低位肛门横断术。术后6个月，高位横断术后吻合口的中位（范围）高度为5.2（3.2 - 6.0）cm，而低位横断术后为2.9（1.8 - 3.6）cm。高位肛门横断术后20例患者中有19例在远端“甜甜圈”处有柱状上皮，而低位横断术后18例中有16例。高位肛门横断且有柱状黏膜的患者中，19个“甜甜圈”中有12个存在活动性结肠炎，低位横断术后16个中有7个存在活动性结肠炎。9例患者（高位横断2例，低位横断7例；P < 0.05）在吻合器远端“甜甜圈”处有横纹肌。在1例溃疡性结肠炎患者的切除结肠中发现发育异常，在2例结肠切除标本中发现腺癌（溃疡性结肠炎1例，FAP 1例）。溃疡性结肠炎患者的任何“甜甜圈”中均未发现发育异常或癌。4例FAP患者（高位横断2例，低位横断2例）在远端“甜甜圈”处有微腺瘤。尽管试图将吻合器袋 - 肛门吻合术置于肛门移行区下方，但在大多数患者（18例中的16例）中，仍无法从剩余肛管完全切除柱状黏膜。在保留直肠结肠切除术中，高位肛门横断和袋 - 肛门吻合术应作为首选方案，因为齿状线吻合可能无法完全消除柱状上皮，并且可能涉及部分外括约肌的切除。
