Pronio A, Montesani C, Vecchione A, Giovagnoli M G, Giarnieri E, Nardi F, Nigri G, Ribotta G
University of Rome La Sapienza VI Department of Surgery, Italy.
Hepatogastroenterology. 1997 May-Jun;44(15):691-7.
BACKGROUND/AIMS: The pathological changes and the risk of developing cancer in the ileal pouch mucosa of patients who received restorative proctocolectomy with ileal pouch-anal anastomosis (IPAA) were studied. The presence or absence of remaining rectal mucosa below the IPAA in both patients with stapled and handsewn IPAA was also examined.
Endoscopy of the ileal pouch was performed on 38 patients at 4, 12, 18 and 36 months after restorative proctocolectomy with ileal pouch. Mucosal biopsy specimens were taken from the ileal reservoir in order to assess the histological incidence of inflammation. In 23 patients, biopsies were taken to perform cytometric DNA analysis. Clinical symptoms of pouchitis (over six evacuations in 24 hours, night-time evacuations, leakage of feces, bloody diarrhea, abdominal pain and fever) were recorded and correlated with the histological findings. Biopsies were also sampled below the ileo-anal anastomosis (IPAA) in order to identify residual rectal mucosa.
Results of histological assessment showed various degrees of chronic inflammation increasing over time (from 42 to 60%) while the presence of both acute and chronic inflammation of the reservoir was less frequent (from 18 to 30%). Villous atrophy was present in 39-68% of patients and the grade of villous atrophy was correlated to the grade of inflammation. Clinical pouchitis was present in 3 to 8% of cases at the different controls and it was always associated with the highest grade of histological inflammation and severe villous atrophy. No significant alteration of the DNA cellular content was observed. Very low incidence of aneuploidy (0.7-1% Ex.R.) has been reported in three cases. However, we found dysplasia in only one patient who underwent surgical treatment for familial polyposis coli. IPAA evaluation showed no residual rectal mucosa in 40% of cases with stapled IPAA; in the remaining 60%, we found a small amount of rectal mucosa (maximum 1 cm). We did not find rectal mucosa after handsewn IPAA with mucosectomy.
Patients treated with restorative proctocolectomy with IPAA showed a higher and increased incidence of inflammation during follow-up. No significant alteration of DNA cellular content nor dysplasia of the pouch mucosa were observed. In this study the chance of leaving rectal mucosa after stapled IPAA was about 60%.
背景/目的：研究接受保留回肠袋肛管吻合术（IPAA）的直肠结肠切除术后患者回肠袋黏膜的病理变化及患癌风险。同时检查了采用吻合器和手工缝合IPAA的患者在IPAA下方是否存在残留直肠黏膜。
对38例接受保留回肠袋直肠结肠切除术的患者，在术后4、12、18和36个月进行回肠袋内镜检查。从回肠储袋取黏膜活检标本，以评估炎症的组织学发生率。对23例患者进行活检以进行细胞DNA分析。记录袋炎的临床症状（24小时内排便超过6次、夜间排便、粪便渗漏、血性腹泻、腹痛和发热），并与组织学结果相关联。还在回肠肛管吻合术（IPAA）下方取活检标本，以识别残留直肠黏膜。
组织学评估结果显示，慢性炎症程度随时间增加（从42%增至60%），而储袋同时存在急性和慢性炎症的情况较少见（从18%降至30%）。39% - 68%的患者存在绒毛萎缩，绒毛萎缩程度与炎症程度相关。在不同检查时，3% - 8%的病例出现临床袋炎，且总是与最高级别的组织学炎症和严重绒毛萎缩相关。未观察到DNA细胞含量的显著改变。在3例患者中报告了极低的非整倍体发生率（0.7% - 1% Ex.R.）。然而，我们仅在1例因家族性结肠息肉病接受手术治疗的患者中发现了发育异常。IPAA评估显示，40%采用吻合器IPAA的病例未发现残留直肠黏膜；在其余60%的病例中，我们发现了少量直肠黏膜（最大1厘米）。在进行黏膜切除的手工缝合IPAA术后未发现直肠黏膜。
接受IPAA直肠结肠切除术的患者在随访期间炎症发生率较高且呈上升趋势。未观察到DNA细胞含量的显著改变，也未发现袋黏膜发育异常。在本研究中，采用吻合器IPAA术后残留直肠黏膜的几率约为60%。
