Khubchandani I T, Kontostolis S B
Department of Colon and Rectal Surgery, Lehigh Valley Hospital, Allentown, Pa.
Arch Surg. 1994 Aug;129(8):866-9. doi: 10.1001/archsurg.1994.01420320092018.
To reevaluate the role of ileorectal anastomosis (IRA) following total colectomy for inflammatory bowel disease in relation to the recent popularity of ileoanal reservoir anastomosis.
In a retrospective analysis of 255 patients who underwent colectomy for inflammatory bowel disease, we found that 144 patients had IRAs: 68 for ulcerative colitis and 76 for Crohn's disease. The follow-up ranged from 6 months to 30 years (mean, 22 years).
A community teaching hospital. Patient compliance for close surveillance was sine qua non in selection.
Patients with ulcerative colitis or Crohn's disease who were selected for IRA if the anal sphincter apparatus was not severely compromised by perineal suppurative disease, if the conventional medical therapies had failed, if the rectum was relatively distensible, and if primary anastomosis was seen to be free of severe inflammatory disease.
Primary IRA was performed in 74 patients in whom the rectum was relatively healthy; in 63 patients, temporary end ileostomy with a mucus fistula was performed. The rectal stump was treated with topical steroids, and a secondary anastomosis was performed.
The quality of life, rate of subsequent rectal excision, and development of carcinoma in the rectum were assessed to determine the validity of and appropriate recommendation for this procedure.
In a follow-up of 1 to 33 years, 129 patients had functioning IRAs. Four patients with functioning IRAs died of unrelated causes. Eight proctectomies (11.7%) were performed in patients with ulcerative colitis, seven (9.2%) in patients with intractable Crohn's disease, and two (1.4%) in patients with cancer.
An IRA following total colectomy for patients with ulcerative colitis or Crohn's disease is an acceptable alternative when the sphincter mechanism is intact and the rectum is distensible. Close surveillance is necessary.
鉴于回肠肛管储袋吻合术近来颇受青睐，重新评估全结肠切除术后回肠直肠吻合术（IRA）在炎性肠病中的作用。
对255例行炎性肠病结肠切除术的患者进行回顾性分析，我们发现144例患者接受了IRA：68例为溃疡性结肠炎，76例为克罗恩病。随访时间为6个月至30年（平均22年）。
一家社区教学医院。选择患者时，密切监测的患者依从性是必不可少的条件。
溃疡性结肠炎或克罗恩病患者，若肛门括约肌未因会阴部化脓性疾病而严重受损、传统药物治疗失败、直肠相对可扩张且初次吻合未见严重炎性疾病，则选择IRA。
74例直肠相对健康的患者接受了初次IRA；63例患者行临时末端回肠造口术并伴有黏液瘘。直肠残端用局部类固醇治疗，然后进行二期吻合。
评估生活质量、后续直肠切除率及直肠癌的发生情况，以确定该手术的有效性及合适的推荐方案。
在1至33年的随访中，129例患者的IRA功能良好。4例IRA功能良好的患者死于无关原因。溃疡性结肠炎患者中有8例行直肠切除术（11.7%），难治性克罗恩病患者中有7例（9.2%），癌症患者中有2例（1.4%）。
对于溃疡性结肠炎或克罗恩病患者，若括约肌功能完好且直肠可扩张，全结肠切除术后IRA是一种可接受的替代方案。密切监测是必要的。
