Fischer J E, Nussbaum M S, Martin L W, Warner B W, Flesch L, Staneck J L, Niemer E, Bjornson H S, Thompson R, McFadden D W
Department of Surgery, University of Cincinnati Medical Center, OH 45267-0558.
Surgery. 1993 Oct;114(4):828-34; discussion 834-5.
The purpose of the study was to review those features that we believed to be critical to the successful performance of the ileal pouch-anal anastomosis, or pull-through, procedure, and specifically the complication of pouchitis.
The charts of 205 patients who successfully underwent ileal pouch-anal anastomosis procedure were reviewed. No follow-up was available in five patients; therefore, the basis of this report and its analysis was based on 200 consecutive procedures in which at least two of the three surgeons participated. Particular emphasis was placed on continence, particularly nighttime continence. The incidence of pouchitis, either a single episode or intermittent episodes, was surveyed. Particular attention was paid to the level of rectal mucosectomy and anastomosis at the top of the columns of Morgagni, thus retaining the transitional zone.
Only 5% of patients were incontinent in the absence of pouchitis. Twenty-five patients (13%) wore a pad at night, but only nine (5%) wore a pad during the day. Of those patients with pouchitis, 6% (12) have had a single episode and 12% (23) were intermittently on medication. Therapy of pouchitis was usually carried out with ciprofloxacin 500 mg by mouth everyday or twice a day.
Ileal pouch-anal anastomosis is an excellent procedure, provided technical details are adhered to. Satisfactory outcome with respect to nighttime continence can be achieved with rectal mucosectomy with minimal manipulation and retaining the transitional epithelium, performing the pouch anastomosis at the top of the columns of Morgagni. The incidence of pouchitis is disappointing but need not be inhibiting of either patients or carrying out this life-saving procedure in patients with ulcerative colitis and familial polyposis.
本研究旨在回顾那些我们认为对回肠储袋肛管吻合术（即拖出术）的成功实施至关重要的特征，特别是储袋炎并发症。
回顾了205例成功接受回肠储袋肛管吻合术患者的病历。5例患者无随访信息；因此，本报告及其分析基于200例连续手术，其中至少有三位外科医生中的两位参与。特别强调了控便情况，尤其是夜间控便。调查了储袋炎的发生率，无论是单次发作还是间歇性发作。特别关注直肠黏膜切除术的水平以及在莫尔加尼柱顶部的吻合情况，从而保留过渡区。
在无储袋炎的情况下，仅有5%的患者存在失禁。25例患者（13%）夜间使用护垫，但白天仅9例（5%）使用。在患有储袋炎的患者中，6%（12例）有单次发作，12%（23例）间歇性接受药物治疗。储袋炎的治疗通常采用口服环丙沙星500毫克，每日一次或每日两次。
只要遵循技术细节，回肠储袋肛管吻合术是一种出色的手术方法。通过直肠黏膜切除术，操作尽量轻柔并保留过渡上皮，在莫尔加尼柱顶部进行储袋吻合术，可在夜间控便方面取得满意效果。储袋炎的发生率令人失望，但对于溃疡性结肠炎和家族性腺瘤性息肉病患者而言，不应因此阻碍患者接受这种挽救生命的手术。
