Sugerman H J, Newsome H H
Department of Surgery, Medical College of Virginia, Virginia Commonwealth University, Richmond 23298.
Am J Surg. 1994 Jan;167(1):58-65; discussion 65-6. doi: 10.1016/0002-9610(94)90054-x.
Stapled J-pouch ileoanal operations were performed in 75 patients (35 men, 40 women; 72 with ulcerative colitis, 3 with familial polyposis) without an ileostomy in 68 (43 taking prednisone, 12 emergent surgery, 8 completion proctectomy with ileostomy takedown). The seven primary ileostomies were due to technical difficulties in two patients and toxic colitis in four patients. No patients were lost to follow-up. Of patients followed for more than 1 month, 96% had perfect daytime control, 86% had no nocturnal accidents, and 73% had no nocturnal spotting. Mucosa between the dentate line and the anastomosis averaged 1.1 +/- 1.0 cm, with the anastomosis at, or below, the dentate line in 16 patients, of whom 14 had excellent continence. Stools in 24 hours averaged 6.9 +/- 0.3, of which 1.8 +/- 0.2 were at night. Stool frequency was unrelated to gender, anastomotic distance from the dentate line, or age; however, patients 50 years of age or older had more problems with nocturnal fecal control than those younger than 50 years of age. Anastomotic leaks (four), cuff abscess (one), pouch leaks (two), and pelvic abscesses (three) were treated with drainage in all patients and ileostomy in five. Pouchitis occurred in 31% of patients and responded to oral antibiotic therapy. Acute complications were fewer, functional pouches greater, stool control better, and overall hospitalization shorter (all p < 0.01) than those in our 63 patients with a mucosectomy and handsewn ileoanal anastomosis.
对75例患者（35例男性，40例女性；72例溃疡性结肠炎患者，3例家族性息肉病患者）实施了吻合器J形贮袋回肠肛管手术，其中68例未行回肠造口术（43例服用泼尼松，12例行急诊手术，8例行全直肠切除术并回肠造口还纳术）。7例初次行回肠造口术的原因是2例患者存在技术困难，4例患者发生中毒性结肠炎。无患者失访。随访超过1个月的患者中，96%白天排便完全可控，86%夜间无排便失禁，73%夜间无粪便沾染。齿状线与吻合口之间的黏膜平均为1.1±1.0 cm，16例患者的吻合口位于齿状线或其下方，其中14例控便良好。24小时排便平均6.9±0.3次，其中夜间排便1.8±0.2次。排便频率与性别、吻合口距齿状线的距离或年龄无关；然而，50岁及以上患者夜间排便控制问题比50岁以下患者更多。所有患者均采用引流治疗吻合口漏（4例）、袖套脓肿（1例）、贮袋漏（2例）和盆腔脓肿（3例），5例患者行回肠造口术。31%的患者发生贮袋炎，口服抗生素治疗有效。与我们63例行黏膜切除术和手工缝合回肠肛管吻合术的患者相比，急性并发症更少，功能性贮袋更多，排便控制更好，总体住院时间更短（均p<0.01）。
