Körsgen S, Keighley M R
University Department of Surgery, Queen Elizabeth Hospital, Edgbaston, Birmingham, UK.
Int J Colorectal Dis. 1997;12(1):4-8. doi: 10.1007/s003840050069.
180 ileoanal pouches constructed over 10 years and followed for at least 2 years (154 for Inflammatory Bowel Disease (IBD) and 26 for Familial Adenomatous Polyposis (FAP)) were reviewed. 23 pouches have been excised to date, 8 remain defunctioned (pouch failure FAP 7.7%, IBD 18.8%). The reasons for excision were: ischemia (n = 6), pelvic sepsis (n = 5), severe stenosis (n = 3), underlying Crohn's disease (n = 3), poor function (n = 5) and fistula (n = 1). The reasons for defunction were: Crohn's disease (n = 1), pelvic sepsis (n = 5) and ileoanal stenosis (n = 2). The projected overall pouch survival rate (Life table analysis) at 5 years was 81% (confidence interval 74-87%). Beyond 7 years, the figures to calculate survival became unreliable (small numbers). There was a significant association between pouch failure and pelvic sepsis (Fisher's exact test P < 0.0001) and between failure and fistula formation (P < 0.02). Multiple regression analysis showed pelvic sepsis and recurrent pouchitis to be independent factors of pouch failure. Pouch failure can occur many years after initial operation. Long-term follow up is recommended.
回顾了10年间构建的180个回肠肛管袋，并对其进行了至少2年的随访（154个用于炎症性肠病（IBD），26个用于家族性腺瘤性息肉病（FAP））。迄今为止，已切除23个袋，8个仍处于失功能状态（袋失败：FAP为7.7%，IBD为18.8%）。切除的原因包括：缺血（n = 6）、盆腔感染（n = 5）、严重狭窄（n = 3）、潜在的克罗恩病（n = 3）、功能不良（n = 5）和瘘管（n = 1）。失功能的原因包括：克罗恩病（n = 1）、盆腔感染（n = 5）和回肠肛管狭窄（n = 2）。5年时预计的袋总体生存率（生命表分析）为81%（置信区间74 - 87%）。7年以后，计算生存率的数据变得不可靠（数量少）。袋失败与盆腔感染之间存在显著关联（Fisher精确检验P < 0.0001），与瘘管形成之间也存在关联（P < 0.02）。多元回归分析显示盆腔感染和复发性袋炎是袋失败的独立因素。袋失败可在初次手术后多年发生。建议进行长期随访。
