Chevallier J M, Ratelle R, Frileux P, Tiret E, Huguet C, Malafosse M, Loygue J, Parc R
Centre de Chirurgie Digestive, Hôpital Saint-Antoine, Paris.
Gastroenterol Clin Biol. 1993;17(10):723-32.
Eighty-three consecutive patients (38 men, 45 women) underwent colectomy and ileorectal anastomosis (IRA) for Crohn's colitis between 1960 and 1988. The mean age at the time of IRA was 28.5 years after a mean interval of four years from diagnosis. At the time of IRA, 31 patients had proctitis, while 25 had perianal disease. Two patients died postoperatively. Postoperative complications appeared in 21 cases (25.3%) including 7 anastomotic leaks (13.2%). Leakage did not imply IRA compromise and the diverting ileostomy did not decrease the risk of preservation of the ileorectal anastomosis. With a mean follow-up of 8 years after IRA, among the 81 surviving patients, it was necessary to retain the stomy in five, 24 required exclusion or excision of their IRA (10 defunctioning ileostomies, 14 proctectomies) and 52 still had a functioning IRA at follow-up (64.2%). Among the 43 recurrences (53%), 21 underwent reoperation. The mean interval between IRA and recurrence was 2.2 years. The cumulative rate of recurrence reached 47% at 5 years and 57% at 10 years. Fifty percent of the patients still had a functioning IRA and were satisfied. Preoperative ileal lesions affected the functional results of the IRA and the recurrence rate. Development of ileal, rectal or anal disease after IRA significantly increased the risk of exclusion of the rectum but did not require suppression of anal function. Patients under 30 years of age or patients suffering for more than 5 years had poorer functional results and more frequent reoperations at 5 years. Rectal preservation after IRA may be proposed with success to patients with a healthy rectum or with minimal or moderate proctitis, even if there is perianal disease that could be safely treated before IRA. In this last setting, the patient has to be informed of the risk of rectal preservation and the possible risk of requiring ulterior proctectomy.
1960年至1988年间，83例连续性患者（38例男性，45例女性）因克罗恩病性结肠炎接受了结肠切除术和回肠直肠吻合术（IRA）。IRA手术时的平均年龄为28.5岁，自诊断起平均间隔4年。IRA手术时，31例患者患有直肠炎，25例患有肛周疾病。2例患者术后死亡。术后并发症出现在21例（25.3%）患者中，包括7例吻合口漏（13.2%）。吻合口漏并不意味着IRA手术失败，且转流性回肠造口术并未降低保留回肠直肠吻合口的风险。IRA术后平均随访8年，在81例存活患者中，5例需要保留造口，24例需要对IRA进行旷置或切除（10例回肠造口失功，14例直肠切除术），52例在随访时仍有功能良好的IRA（64.2%）。在43例复发患者（53%）中，21例接受了再次手术。IRA手术至复发的平均间隔时间为2.2年。5年时复发的累积发生率达到47%，10年时为57%。50%的患者仍有功能良好的IRA且感到满意。术前回肠病变影响IRA的功能结果和复发率。IRA术后回肠、直肠或肛门疾病的发生显著增加了直肠旷置的风险，但并不需要抑制肛门功能。30岁以下的患者或患病超过5年的患者在5年时功能结果较差且再次手术更为频繁。对于直肠健康或患有轻度或中度直肠炎的患者，即使存在可在IRA手术前安全治疗的肛周疾病，也可成功提议保留直肠进行IRA手术。在最后这种情况下，必须告知患者保留直肠的风险以及可能需要后续直肠切除术的风险。
