Ogunbiyi O A, Korsgen S, Keighley M R
University Department of Surgery, Queen Elizabeth Hospital, University of Birmingham, Edgbaston, United Kingdom.
Dis Colon Rectum. 1997 May;40(5):548-52. doi: 10.1007/BF02055376.
The aim of this study was to determine the outcome of pouch salvage operations and the factors that may influence successful reconstructions.
This retrospective review includes data from 198 patients who had undergone restorative proctocolectomy at a single institution during an 11-year period. All patients who had undergone attempted pouch salvage and who still had a pouch in situ were reviewed by both postal questionnaire and at interview in the outpatients clinic.
Of 198 patients who underwent restorative proctocolectomy and ileal pouch-anal anastomosis, 27 (13.6 percent) presented with pouch-specific complications requiring pouch salvage. A further five patients requiring pouch salvage were referred from other centers. Of 32 patients who underwent attempted pouch salvage, 16 (50 percent) had a successful outcome, 12 (37.5 percent) had pouch excision, and 3 (9 percent) are still defunctioned. There was one death (3 percent) in this series. Pelvic sepsis was a major cause of pouch failure, being present in 50 percent (8/16) of failed salvage procedures, and accounting for 58 percent (7/12) of pouch excisions.
Salvage surgery for major complications following ileoanal pouch construction is worthwhile in the absence of major pelvic sepsis. Overall success rate is 50 percent, and these results may be acceptable to highly motivated patients.
本研究旨在确定回肠储袋挽救手术的结果以及可能影响成功重建的因素。
这项回顾性研究纳入了11年间在单一机构接受保留肛门直肠切除术的198例患者的数据。所有尝试进行储袋挽救且仍保留储袋的患者均通过邮寄问卷和门诊访谈进行了评估。
在198例行保留肛门直肠切除术和回肠储袋肛管吻合术的患者中，27例（13.6%）出现了需要进行储袋挽救的储袋特异性并发症。另有5例需要储袋挽救的患者是从其他中心转诊而来。在32例尝试进行储袋挽救的患者中，16例（50%）获得了成功，12例（37.5%）进行了储袋切除，3例（9%）仍处于失功状态。该系列中有1例死亡（3%）。盆腔感染是储袋失败的主要原因，在50%（8/16）的挽救失败手术中存在，占储袋切除病例的58%（7/12）。
在没有严重盆腔感染的情况下，针对回肠肛管储袋构建术后主要并发症的挽救手术是值得的。总体成功率为50%，对于积极性高的患者来说，这些结果可能是可以接受的。
