Ecker K W, Haberer M, Feifel G
Department of General, Abdominal and Vascular Surgery, University of Saarland, Homburg/Saar, Germany.
Dis Colon Rectum. 1996 Sep;39(9):977-80. doi: 10.1007/BF02054684.
We report the indications, technique, and results of conversion of the ileoanal pouch to the Kock's pouch in five patients. The indication was functional disturbance that could not be corrected by operation. Aim of the conversion operation was re-establishment of fecal control and complete preservation of existing ileal surface.
The ileal pouch was used again, and in one case an augmentation was made. The continence valve was made three times from the afferent loop and in two cases from a higher ileal segment.
Following conversion, function was excellent in three patients with ulcerative colitis and in one patient with familial adenomatous polyposis. One woman who underwent proctocolectomy for slow-transit constipation needed a Brooke ileostomy for continuous abdominal distention pain.
We conclude that conversion to a continent ileostomy is a rewarding method of safely eliminating dysfunction of the ileoanal pouch that cannot be corrected by operation. Presumption is, however, that the surgeon is familiar with both methods and that the primary disease is suitable for pouch surgery.
我们报告了5例患者回肠肛管袋转换为科克袋的适应证、技术及结果。适应证为无法通过手术纠正的功能障碍。转换手术的目的是重建粪便控制并完全保留现有的回肠表面。
再次使用回肠袋，1例进行了扩大。节制瓣膜3次由传入袢制作，2例由更高的回肠段制作。
转换后，3例溃疡性结肠炎患者和1例家族性腺瘤性息肉病患者功能良好。1例因慢传输型便秘接受全直肠系膜切除术的女性因持续性腹胀疼痛需要行布鲁克回肠造口术。
我们得出结论，转换为可控性回肠造口术是一种安全消除无法通过手术纠正的回肠肛管袋功能障碍的有效方法。然而，前提是外科医生熟悉这两种方法且原发性疾病适合行袋状手术。
