Mikkola K, Luukkonen P, Järvinen H J
Second Department of Surgery, Helsinki University Central Hospital, Finland.
Eur J Surg. 1996 Apr;162(4):315-9.
To evaluate the clinical differences between conventional and restorative proctocolectomy in the treatment of ulcerative colitis.
Retrospective analysis.
University hospital, Finland.
240 consecutive patients with ulcerative colitis who underwent elective proctocolectomy between 1976 and 1990.
Proctocolectomy and conventional ileostomy (n = 119) or restorative proctocolectomy (n = 121).
Early and late surgical morbidity and recovery time.
There were no postoperative deaths after restorative proctocolectomy and one patient (1%) died after conventional proctocolectomy. Two other patients (2%) with ileostomies died of late complications. Delayed perineal would healing after conventional ileostomy (n = 45, 38%) and either early (n = 31, 26%) or late (n = 19, 16%) defects of the ileoanal anastomosis after restorative proctocolectomy caused most problems. Reoperations (early or late) were needed in 45 (38%) and 44 (36%) patients after Brooke ileostomy and restorative proctocolectomy, respectively. Major complications, however, were more common and the duration of sick leave was a month longer in the pouch group.
Ulcerative colitis can safely be managed with either conventional or restorative proctocolectomy. In most cases the patient's preference should dictate the choice of procedure.
评估传统直肠结肠切除术与保留肛门的直肠结肠切除术在治疗溃疡性结肠炎方面的临床差异。
回顾性分析。
芬兰大学医院。
1976年至1990年间连续接受择期直肠结肠切除术的240例溃疡性结肠炎患者。
直肠结肠切除术及传统回肠造口术（n = 119）或保留肛门的直肠结肠切除术（n = 121）。
早期和晚期手术并发症及恢复时间。
保留肛门的直肠结肠切除术后无术后死亡病例，1例（1%）患者在传统直肠结肠切除术后死亡。另外2例（2%）回肠造口患者死于晚期并发症。传统回肠造口术后会阴部伤口愈合延迟（n = 45，38%），保留肛门的直肠结肠切除术后回肠肛管吻合口早期（n = 31，26%）或晚期（n = 19，16%）出现缺损是最主要的问题。布鲁克回肠造口术和保留肛门的直肠结肠切除术后分别有45例（38%）和44例（36%）患者需要再次手术（早期或晚期）。然而，主要并发症在储袋组更为常见，病假时间也长一个月。
溃疡性结肠炎采用传统或保留肛门的直肠结肠切除术均可安全治疗。在大多数情况下，应根据患者的偏好来决定手术方式。
