Kartheuser A H, Dozois R R, LaRusso N F, Wiesner R H, Ilstrup D M, Schleck C D
Department of Surgery, Mayo Clinic Rochester, MN 55905, USA.
Mayo Clin Proc. 1996 Aug;71(8):748-56. doi: 10.4065/71.8.748.
To compare the operative risks, operative complications, and late outcome of two homogeneous groups of patients with chronic ulcerative colitis (CUC) and primary sclerosing cholangitis (PSC) who underwent either Brooke ileostomy or ileal pouch-anal anastomosis (IPAA).
Between 1970 and 1990, 72 patients with CUC and PSC underwent proctocolectomy with either Brooke ileostomy (group I; N = 32) or IPAA (group II; N = 40). Postoperative data included operative mortality, need for blood transfusion, general postoperative complications, liver-related complications, and proctocolectomy-related complications.
Eight group I patients and nine group II patients had a total of 12 and 11 general complications, respectively. Liver-related complications were diagnosed in 16% and 10% of group I and group II patients, respectively. Proctocolectomy-specific complications occurred in 34% of group I and 20% of group II patients. The overall need for blood transfusion was 94% in group I and 47% in group II (P < 0.001). The cumulative probability of proctocolectomy-related complications at 5 years was 23% for group I and 64% for group II patients (P < 0.002). The difference, however, was primarily due to the high frequency of pouchitis after IPAA, estimated at 57% at 4 years. The cumulative 5-year risk of liver-related complications was 37% and 28% for group I and group II, respectively. Peristomal varices and bleeding occurred in eight group I patients but in none of group II.
Because IPAA avoids bleeding problems, it is the surgical treatment of choice in patients with PSC and CUC.
比较两组病情相似、均患有慢性溃疡性结肠炎（CUC）和原发性硬化性胆管炎（PSC）且分别接受布鲁克回肠造口术或回肠贮袋肛管吻合术（IPAA）的患者的手术风险、手术并发症及远期疗效。
1970年至1990年间，72例患有CUC和PSC的患者接受了全直肠结肠切除术，其中32例接受布鲁克回肠造口术（第一组），40例接受IPAA（第二组）。术后数据包括手术死亡率、输血需求、一般术后并发症、肝脏相关并发症以及全直肠结肠切除术相关并发症。
第一组8例患者和第二组9例患者分别共有12例和11例一般并发症。第一组和第二组患者中分别有16%和10%被诊断出有肝脏相关并发症。全直肠结肠切除术特异性并发症在第一组患者中的发生率为34%，在第二组患者中的发生率为20%。第一组患者的总体输血需求为94%，第二组为47%（P<0.001）。第一组患者在5年时全直肠结肠切除术相关并发症的累积概率为23%，第二组患者为64%（P<0.002）。然而，这种差异主要是由于IPAA术后袋炎发生率较高，4年时估计为57%。第一组和第二组患者肝脏相关并发症的累积5年风险分别为37%和28%。第一组8例患者出现造口周围静脉曲张和出血，而第二组无此情况。
由于IPAA可避免出血问题，它是PSC和CUC患者的首选手术治疗方法。
