Järvinen H J, Luukkonen P
Second Department of Surgery, Helsinki University Central Hospital, Finland.
Ann Chir Gynaecol. 1993;82(3):159-64.
Two hundred and one patients underwent restorative proctocolectomy between January 1985 and January 1993. The underlying disease was ulcerative colitis in 191 and familial adenomatous polyposis in ten patients. All patients had a J pouch and, except for 22 patients, total mucosectomy was performed. The procedure was technically successful in 200 cases (99.5%). There was no postoperative mortality, but two patients died soon afterwards due to unrelated causes (suicide, upper gastrointestinal bleeding). Early postoperative complications were observed in 33% of patients and 21% required reoperations, most often because of haemorrhage or pelvic sepsis. Late morbidity rate was 29% including reoperations in 31 patients (17%) and conversion to permanent ileostomy in five cases (2.5%). The most common late problems were anal sinus, stricture or fistula (11%) and episodic or chronic pouchitis (20%). The functional result was evaluated in 150 patients followed up for one year. the mean bowel frequency was 5.6 times in 24 hours, 19% of patients had minor anal soiling and 11% required a protective pad. It is concluded that restorative proctocolectomy has become the first choice for most patients with ulcerative colitis and familial adenomatous polyposis.
1985年1月至1993年1月期间，201例患者接受了保留肛门的直肠结肠切除术。其中191例患者的基础疾病为溃疡性结肠炎，10例为家族性腺瘤性息肉病。所有患者均采用J形贮袋，除22例患者外，均进行了全黏膜切除术。该手术在200例患者中技术成功（99.5%）。术后无死亡病例，但有2例患者术后不久因无关原因死亡（自杀、上消化道出血）。33%的患者出现早期术后并发症，21%的患者需要再次手术，最常见的原因是出血或盆腔感染。晚期发病率为29%，包括31例患者（17%）再次手术和5例患者（2.5%）转为永久性回肠造口术。最常见的晚期问题是肛窦、狭窄或瘘管（11%）以及间歇性或慢性贮袋炎（20%）。对150例随访1年的患者进行了功能评估。平均排便频率为24小时5.6次，19%的患者有轻度肛门污染，11%的患者需要使用护垫。结论是，保留肛门的直肠结肠切除术已成为大多数溃疡性结肠炎和家族性腺瘤性息肉病患者的首选治疗方法。
