Lewis W G, Kuzu A, Sagar P M, Holdsworth P J, Johnston D
Academic Unit of Surgery, General Infirmary, Leeds, United Kingdom.
Dis Colon Rectum. 1994 Feb;37(2):120-5. doi: 10.1007/BF02047532.
The aim of this study was to determine what factors may be responsible for the development of a stricture at the pouch-anal anastomosis after restorative proctocolectomy.
A consecutive series of 115 patients was studied retrospectively a median of 34 months (range, 4-100 months) after operation or ileostomy closure. The procedure failed in 11 patients (9.6 percent) who subsequently had to have a permanent ileostomy. Another two patients were excluded from the analysis, one of whom was awaiting ileostomy closure, whereas the other had a stricture due to a desmoid tumor. Of the remaining 102 patients, 39 (38 percent) developed an ileoanal anastomotic stricture, which was severe and persistent in 16 percent.
The results were analyzed with the aid of multivariate logistic regression analysis. Factors which predisposed significantly to the development of an ileoanal anastomotic stricture were 1) use of the 25-mm (small) diameter stapling gun (P = 0.05), 3) use of a defunctioning ileostomy (P = 0.03), and 4) anastomotic dehiscence and pelvic sepsis (P = 0.03). The single patient whose operation failed because of a stricture had also developed pelvic sepsis associated with an anastomotic dehiscence.
The eventual clinical, functional outcome after dilation of a stricture in the 39 patients who developed a stricture was as good as the outcome in the 63 patients who did not a develop stricture.
本研究旨在确定在结直肠切除术后回肠贮袋肛管吻合口发生狭窄的可能相关因素。
对连续的115例患者进行回顾性研究，术后或回肠造口关闭后的中位时间为34个月（范围4 - 100个月）。11例患者（9.6%）手术失败，随后不得不进行永久性回肠造口。另外2例患者被排除在分析之外，其中1例等待回肠造口关闭，另1例因硬纤维瘤导致狭窄。在其余102例患者中，39例（38%）发生了回肠肛管吻合口狭窄，其中16%为严重且持续性狭窄。
借助多因素逻辑回归分析对结果进行分析。显著易导致回肠肛管吻合口狭窄发生的因素有：1）使用25mm（小）直径吻合器（P = 0.05），3）使用减功能回肠造口（P = 0.03），以及4）吻合口裂开和盆腔感染（P = 0.03）。因狭窄导致手术失败的唯一1例患者也发生了与吻合口裂开相关的盆腔感染。
39例发生狭窄的患者经扩张后最终的临床和功能结局与63例未发生狭窄的患者结局相当。
