Tjandra J J, Fazio V W, Church J M, Oakley J R, Milsom J W, Lavery I C
Department of Colorectal Surgery, Cleveland Clinic Foundation, Ohio 44195.
Am J Surg. 1993 Mar;165(3):322-5. doi: 10.1016/s0002-9610(05)80834-7.
Restorative proctocolectomy (RP) is generally considered to achieve better results in patients with familial adenomatous polyposis (FAP) than in those with mucosal ulcerative colitis (MUC). We studied 39 pairs of patients (FAP versus MUC), individually matched for surgeon (n = 4), types of ileal pouch (19 S-pouches and 20 J-pouches), technique of ileal pouch-anal anastomosis (21 stapled, 18 handsewn with mucosectomy), duration of follow-up after pouch function (median: 32 months; range: 6 months to 8.5 years), age (median: 30 years; range: 12 to 60 years), and gender (male-to-female ratio: 1.4:1.0). The median duration of operation (3.2 hours), hospital stay (9 days), and the amount of blood loss (about 650 mL) were similar between the two groups. The patients in the MUC group tended to have a higher overall complication rate (28% versus 21%) and more pouch-related septic complications (13% versus 8%, p = 0.6 by chi 2 analysis). Functional results were similar for daytime (median: 5 per day) and nighttime (median: 1 per night) stool frequency and the median duration that defecation could be deferred (median: about 1.5 hours). Perfect continence was present in 34 (87%) patients during the day and in 19 (49%) patients during the night in each group. The use of antidiarrheal medications did not differ between the two groups. According to an analogue scale (from 1 to 10, with 10 being best), the quality of life and health and satisfaction with outcome (median score: 9) were identical between the groups. Thus, in closely matched groups of patients with FAP and MUC, the functional outcome after RP was similar. However, pouchitis was more common in the MUC group (33% versus 10%, p < 0.05 by chi 2 analysis).
对于家族性腺瘤性息肉病（FAP）患者，全直肠系膜切除术（RP）通常被认为比黏膜溃疡性结肠炎（MUC）患者能取得更好的效果。我们研究了39对患者（FAP组与MUC组），这些患者在外科医生（n = 4）、回肠储袋类型（19个S形储袋和20个J形储袋）、回肠储袋肛管吻合技术（21例使用吻合器，18例采用带黏膜切除的手工缝合）、储袋功能恢复后的随访时间（中位数：32个月；范围：6个月至8.5年）、年龄（中位数：30岁；范围：12至60岁）以及性别（男女比例：1.4:1.0）方面进行了个体匹配。两组患者的手术中位时长（3.2小时）、住院时间（9天）以及失血量（约650毫升）相似。MUC组患者的总体并发症发生率往往更高（28%对21%），且与储袋相关的感染性并发症更多（13%对8%，经卡方分析p = 0.6）。两组患者白天（中位数：每天5次）和夜间（中位数：每晚1次）的排便频率以及排便可延迟的中位时长（中位数：约1.5小时）的功能结果相似。每组中白天34例（87%）患者和夜间19例（49%）患者实现了完全控便。两组使用止泻药物的情况无差异。根据模拟量表（从1到10，10分为最佳），两组患者的生活质量、健康状况以及对手术结果的满意度（中位数评分：9）相同。因此，在FAP和MUC的紧密匹配患者组中，RP术后的功能结果相似。然而，MUC组的袋炎更为常见（33%对10%，经卡方分析p < 0.05）。
