Penna C, Daude F, Parc R, Tiret E, Frileux P, Hannoun L, Nordlinger B, Levy E
Department of Alimentary Tract Surgery, Hôpital Saint-Antoine, Paris, France.
Dis Colon Rectum. 1993 Apr;36(4):343-8. doi: 10.1007/BF02053936.
The aim of this work was to study the effects of previous subtotal colectomy (STC) with ileostomy and sigmoidostomy on the outcome of ileal J-pouch-anal anastomosis (IPAA) in patients with acute ulcerative colitis. Between 1983 and 1991, we conducted a prospective, nonrandomized study of 156 patients who underwent IPAA in our center. Fifty-five patients (34.3 percent) had undergone STC with ileostomy and sigmoidostomy for either severe acute colitis (36.5 percent of cases) or nonresolving acute colitis (63.5 percent) up to six months before IPAA with covering ileostomy. There were no perioperative deaths; six patients (11 percent) developed complications requiring reoperation (three cases of pelvic sepsis, two occlusions, and one stenosis of the ileostomy). IPAA was successfully carried out at a later stage in all cases. The results of IPAA in these patients were compared with those in 78 patients who underwent the classical two-stage IPAA procedure. The rates of pelvic sepsis and postoperative occlusion were lower in the subgroup of patients who underwent the three-step procedure. Three months after closure of the ileostomy, the mean number of daily stools was significantly lower in the patients who had undergone prior STC (5.09 vs. 5.9), but there was no significant difference between the two groups with regard to diurnal and nocturnal continence, the need to wear a pad, discrimination between gas and stools, or the use of antidiarrheal medication. In addition, there was no significant difference at one year in terms of functional parameters. We conclude that STC is a simple and safe procedure for the treatment of a severe attack of colitis and that it does not compromise the results of later IPAA. Because it does not increase the morbidity of subsequent IPAA and is associated with more rapid functional recovery, STC appears to be suitable for the treatment of patients with nonresolving acute colitis before the onset of malnutrition or steroid dependency.
本研究旨在探讨既往接受回肠造口术和乙状结肠造口术的次全结肠切除术（STC）对急性溃疡性结肠炎患者回肠J袋肛管吻合术（IPAA）结局的影响。1983年至1991年期间，我们对在本中心接受IPAA的156例患者进行了一项前瞻性、非随机研究。55例患者（34.3%）因严重急性结肠炎（36.5%的病例）或未缓解的急性结肠炎（63.5%）在接受IPAA并覆盖回肠造口术之前长达6个月接受了STC并进行回肠造口术和乙状结肠造口术。无围手术期死亡；6例患者（11%）出现需要再次手术的并发症（3例盆腔脓毒症、2例梗阻和1例回肠造口狭窄）。所有病例均在后期成功实施了IPAA。将这些患者的IPAA结果与78例接受经典两阶段IPAA手术的患者的结果进行比较。接受三步手术的患者亚组中盆腔脓毒症和术后梗阻的发生率较低。回肠造口关闭3个月后，既往接受STC的患者每日平均排便次数显著较低（5.09次对5.9次），但两组在日间和夜间控便、使用护垫的必要性、区分气体和粪便或使用止泻药物方面无显著差异。此外，在功能参数方面，1年时两组无显著差异。我们得出结论，STC是治疗严重结肠炎发作的一种简单且安全的手术，并且它不会影响后期IPAA的结果。由于它不会增加后续IPAA的发病率，并且与更快的功能恢复相关，STC似乎适用于在营养不良或类固醇依赖发生之前治疗未缓解的急性结肠炎患者。
