Marcello P W, Roberts P L, Schoetz D J, Coller J A, Murray J J, Veidenheimer M C
Department of Colon-Rectal Surgery, Lahey Clinic, Burlington, Mass.
Arch Surg. 1993 May;128(5):500-3; discussion 503-4. doi: 10.1001/archsurg.1993.01420170030003.
Many surgeons consider the ileoanal pouch procedure to be the procedure of choice for patients who require surgery for ulcerative colitis and familial adenomatous polyposis. To determine long-term results, 460 patients (mean +/- SD age, 31 +/- 9 years) who underwent the ileoanal pouch procedure from 1980 through 1991 were prospectively observed by computerized registry. The leading indication for operation was ulcerative colitis (n = 382; 83%). A J-shaped reservoir was created in 434 patients (94%). More than 5 years after ileostomy closure, the mean number of bowel movements was 5.8 +/- 2.2, and 13% of patients had leakage. Most patients (94%) were satisfied with their results. Sixteen patients (3.5%) required recreation of a permanent stoma for pouch failure. Complications (major and minor) occurred in 266 patients (58%) and included obstruction (n = 94; 20%), pouch fistula (n = 26; 6%), anastomotic stricture (n = 40; 9%), anastomosis separation (n = 14; 3%), and pouchitis (n = 83; 18%). Modifications in technique and increased operative experience have significantly decreased the incidence of obstruction (P = .05) and pouch-related complications (P = .004). Despite complications, long-term results are acceptable, and patient satisfaction remains high.
许多外科医生认为，回肠肛管吻合术是需要接受手术治疗的溃疡性结肠炎和家族性腺瘤性息肉病患者的首选术式。为了确定长期疗效，我们通过计算机登记系统对1980年至1991年间接受回肠肛管吻合术的460例患者（平均年龄±标准差，31±9岁）进行了前瞻性观察。手术的主要指征是溃疡性结肠炎（n = 382；83%）。434例患者（94%）构建了J形贮袋。回肠造口关闭5年多后，平均排便次数为5.8±2.2次，13%的患者有渗漏。大多数患者（94%）对手术结果满意。16例患者（3.5%）因贮袋功能衰竭需要重新造永久性造口。266例患者（58%）发生了并发症（包括严重和轻微并发症），其中包括梗阻（n = 94；20%）、贮袋瘘（n = 26；6%）、吻合口狭窄（n = 40；9%）、吻合口裂开（n = 14；3%）和贮袋炎（n = 83；18%）。技术改进和手术经验的增加显著降低了梗阻发生率（P = 0.05）和与贮袋相关的并发症发生率（P = 0.004）。尽管有并发症，但长期疗效是可以接受的，患者满意度仍然很高。
