McIntyre P B, Pemberton J H, Beart R W, Devine R M, Nivatvongs S
Division of Colon and Rectal Surgery, Mayo Clinic, Rochester, Minnesota 55905.
Dis Colon Rectum. 1994 May;37(5):430-3. doi: 10.1007/BF02076186.
Proctocolectomy with ileal pouch-anal anastomosis (IPAA) is the treatment of choice for most patients with chronic ulcerative colitis. Whether or not a double-stapled technique, which should preserve the anal transition zone and avoid prolonged and dilation, facilitates superior fecal continence compared with conventional mucosal resection and handsewn anastomosis is unknown.
The aim of this study was to compare functional results after double-stapled and handsewn IPAA.
Twenty-seven consecutive patients (13 females, 14 males; mean age, 37 years) who had proctocolectomy and double-stapled IPAA (J) for chronic ulcerative colitis were identified. Each was matched by sex, age, and surgeon to a control who had undergone a conventional handsewn anastomosis. Functional results at six months after ileostomy closure were compared.
Median stool frequency in each group was seven. The prevalence of pouchitis was 22 percent in both groups. One pouch failure occurred in each group. The percentage of patients from the double-stapled group with daytime spotting was similar to that of the handsewn group (18 percent vs. 26 percent, P > 0.5). Nighttime soiling rates were similar as well (41 percent vs. 48 percent, P > 0.5).
Double-stapled IPAA appears to convey no early functional advantage over handsewn IPAA for chronic ulcerative colitis.
全结直肠切除回肠储袋肛管吻合术（IPAA）是大多数慢性溃疡性结肠炎患者的首选治疗方法。与传统的黏膜切除和手工缝合吻合术相比，双吻合器技术是否能保留肛管移行区并避免延长和扩张，从而促进更好的粪便节制尚不清楚。
本研究的目的是比较双吻合器和手工缝合IPAA后的功能结果。
确定27例因慢性溃疡性结肠炎接受全结直肠切除和双吻合器IPAA（J型）的连续患者（13例女性，14例男性；平均年龄37岁）。根据性别、年龄和手术医生将每例患者与接受传统手工缝合吻合术的对照患者进行匹配。比较回肠造口关闭后6个月的功能结果。
每组的中位排便频率均为7次。两组的袋炎患病率均为22%。每组各发生1例储袋失败。双吻合器组白天点滴渗漏患者的百分比与手工缝合组相似（18%对26%，P>0.5）。夜间弄脏率也相似（41%对48%，P>0.5）。
对于慢性溃疡性结肠炎，双吻合器IPAA似乎在早期功能上并不比手工缝合IPAA更具优势。
