Vinge O D, Myrhøj T, Hesselfeldt P, Bülow S
Hvidovre Hospital, kirurgisk gastroenterologisk afdeling.
Ugeskr Laeger. 1996 Apr 8;158(15):2101-4.
Thirty-two patients with ulcerative colitis, median age 29 (range 14-49), were submitted to restorative proctocolectomy. Twenty-five patients had a three-stage procedure and seven had a two-stage procedure. A stapled J-pouch was formed, and a pouch-anal anastomosis was created by the double stapling technique. A temporary end ileostomy was closed through peristomal incision after three months. There were no pouch failures and no cases of pouch-anal anastomosis leakage. In one patient secondary mucosectomy and neo-anastomosis became necessary due to severe inflammation of remnant rectal mucosa. Five patients were operated for small bowel obstruction, and two had to have a dilatation of a slight stricture of the pouch-anal anastomosis. In two patients the final diagnosis was verified or probable Crohns disease, of whom one developed recurrence of a previous rectovaginal fistula. Twenty-seven patients have had the ileostomy closed for more than one month, 25 of these (93%) were fully continent three months after ileostomy closure and later on. After one year the patients had median five (range 3-9) bowel movements per day. It is concluded that restorative proctocolectomy with a stapled J-pouch-anal anastomosis and a temporary end ileostomy for ulcerative colitis carries few complications and provides a good functional result.
32例溃疡性结肠炎患者，中位年龄29岁（范围14 - 49岁），接受了保留直肠结肠切除术。25例患者采用三阶段手术，7例采用两阶段手术。形成了一个吻合器J形贮袋，并通过双吻合器技术进行贮袋肛管吻合术。三个月后通过造口周围切口关闭临时末端回肠造口。没有贮袋失败的情况，也没有贮袋肛管吻合口漏的病例。1例患者因残留直肠黏膜严重炎症需要进行二次黏膜切除术和新的吻合术。5例患者因小肠梗阻接受手术，2例患者需要对贮袋肛管吻合口轻度狭窄进行扩张。2例患者最终诊断为确诊或疑似克罗恩病，其中1例既往直肠阴道瘘复发。27例患者回肠造口关闭已超过1个月，其中25例（93%）在回肠造口关闭及之后三个月完全控便。一年后，患者每天排便次数中位数为5次（范围3 - 9次）。结论是，对于溃疡性结肠炎，采用吻合器J形贮袋肛管吻合术和临时末端回肠造口的保留直肠结肠切除术并发症少，功能效果良好。
