Church J M, Fazio V W, Lavery I C, Oakley J R, Milsom J, McGannon E
Department of Colorectal Surgery, Cleveland Clinic, Ohio, USA.
Dis Colon Rectum. 1996 Dec;39(12):1404-8. doi: 10.1007/BF02054529.
Prophylactic colectomy or proctocolectomy is standard treatment for colorectal manifestation of familial adenomatous polyposis (FAP), a dominantly inherited disorder for which the risk of developing colorectal cancer in an untreated patient is close to 100 percent. Hereditary nonpolyposis colorectal cancer (HNPCC) is also dominantly inherited but has a lower risk of colorectal cancer than FAP and does not have a clinically obvious phenotype. The role of prophylactic colectomy in patients with HNPCC is controversial.
This study was performed to examine the outcome of colectomy and ileorectal anastomosis (IRA) so its use as a prophylactic procedure can be better evaluated.
Records of all patients undergoing IRA for FAP between 1985 and 1993 were reviewed. Demographic data and data about the operation were collected. Surgical outcome data included length of hospital stay, complications, bowel function, quality of life, and patient satisfaction.
There were 51 patients with a median age of 28 years; 24 were male. All but eight patients were asymptomatic, and all had less than 1,000 polyps in the resected specimen. Mean surgery time was 3.5 hours, mean blood loss was 406 ml, and median length of hospital stay was seven days. There were no deaths, and eight patients (16 percent) had complications. Mean number of stools per day after median follow-up of 4.2 years was 3.6. Only 11 patients had nighttime stooling. Four patients reported seepage, 9 had some incontinence, and 16 had urgency. Quality of life, rated on a scale of 0 to 10, was 7 or above in 44 of 48 assessed patients. Quality of health was rated 7 or higher in all 48 patients, energy level was 7 or higher in 39 patients, and overall happiness with surgery was 7 or higher in 47 patients.
Colectomy and IRA is a relatively safe operation that results in minimum disturbance of bowel function. Patient satisfaction is usually high. Prophylactic colectomy can be offered to HNPCC gene carriers with a greater understanding of the likely outcome of surgery.
预防性结肠切除术或直肠结肠切除术是家族性腺瘤性息肉病（FAP）结直肠表现的标准治疗方法，FAP是一种常染色体显性遗传疾病，未经治疗的患者患结直肠癌的风险接近100%。遗传性非息肉病性结直肠癌（HNPCC）也是常染色体显性遗传，但患结直肠癌的风险低于FAP，且没有明显的临床表型。预防性结肠切除术在HNPCC患者中的作用存在争议。
本研究旨在检查结肠切除术和回肠直肠吻合术（IRA）的结果，以便更好地评估其作为一种预防性手术的应用。
回顾了1985年至1993年间所有因FAP接受IRA手术的患者的记录。收集了人口统计学数据和手术相关数据。手术结果数据包括住院时间、并发症、肠道功能、生活质量和患者满意度。
共有51例患者，中位年龄28岁；24例为男性。除8例患者外均无症状，所有患者切除标本中的息肉均少于1000个。平均手术时间为3.5小时，平均失血量为406毫升，中位住院时间为7天。无死亡病例，8例患者（16%）出现并发症。中位随访4.2年后，平均每日排便次数为3.6次。只有11例患者夜间排便。4例患者报告有渗漏，9例有一定程度的失禁，16例有便急。在48例接受评估的患者中，44例的生活质量评分为0至10分，7分及以上。所有48例患者的健康质量评分为7分及以上，39例患者的精力水平评分为7分及以上，47例患者对手术的总体满意度评分为7分及以上。
结肠切除术和IRA是一种相对安全的手术，对肠道功能的干扰最小。患者满意度通常较高。对于HNPCC基因携带者，可以在更清楚了解手术可能结果的情况下提供预防性结肠切除术。
