Jimmo B, Hyman N H
Department of Surgery, University of Vermont College of Medicine, Burlington, USA.
Dis Colon Rectum. 1998 Jan;41(1):41-5. doi: 10.1007/BF02236894.
Ileal pouch-anal anastomosis is widely claimed to have replaced total proctocolectomy with ileostomy as the "procedure of choice" for ulcerative colitis, largely on the basis of a perceived improved quality of life. There exists relatively little support for this assertion in the literature. Our aim was to determine if educated patients choosing total proctocolectomy with ileostomy have a similar quality of life as with ileal pouch-anal anastomosis.
All patients with ulcerative colitis referred to a single surgeon and deemed an appropriate surgical candidate were educated and then offered ileal pouch-anal anastomosis or total proctocolectomy with ileostomy. Age, gender, and complications (including pouchitis) were recorded prospectively, and all patients were questioned regarding functional outcome and level of satisfaction. They were then asked to complete a slightly modified Inflammatory Bowel Disease Questionnaire, which was analyzed by categoric and overall scores.
Sixty-seven patients underwent elective surgery for ulcerative colitis during the study period. Fifty-five patients chose ileal pouch-anal anastomosis, and 12 had total proctocolectomy with ileostomy. The groups were similar except for younger age and longer follow-up in the ileal pouch-anal anastomosis group. Patients undergoing ileal pouch-anal anastomosis had significantly more short-term or long-term complications (49 vs. 8 percent), with pouchitis being the most frequent complication. There was no difference in level of satisfaction between the two groups, and no patient in either group wishes they had undergone the other procedure. There was no difference in the overall or any categoric Inflammatory Bowel Disease Questionnaire score.
Patient satisfaction with both procedures was similarly high. Patients who undergo ileal pouch-anal anastomosis can expect a high level of satisfaction, with a good quality of life. However, educated patients choosing an ileostomy can achieve the same quality of life, without the higher complication rate associated with a pelvic pouch.
回肠储袋肛管吻合术被广泛认为已取代全直肠结肠切除术加回肠造口术，成为溃疡性结肠炎的“首选术式”，这主要基于人们认为其改善了生活质量。然而，文献中对这一观点的支持相对较少。我们的目的是确定选择全直肠结肠切除术加回肠造口术的有知识的患者是否与接受回肠储袋肛管吻合术的患者具有相似的生活质量。
所有转诊至一位外科医生处且被认为是合适手术候选者的溃疡性结肠炎患者均接受了相关教育，然后可选择回肠储袋肛管吻合术或全直肠结肠切除术加回肠造口术。前瞻性记录患者的年龄、性别和并发症（包括储袋炎），并询问所有患者的功能结局和满意度水平。然后要求他们完成一份稍作修改的炎症性肠病问卷，并按分类和总分进行分析。
在研究期间，67例患者因溃疡性结肠炎接受了择期手术。55例患者选择了回肠储袋肛管吻合术，12例接受了全直肠结肠切除术加回肠造口术。除回肠储袋肛管吻合术组年龄较小且随访时间较长外，两组相似。接受回肠储袋肛管吻合术的患者有明显更多的短期或长期并发症（49%对8%），储袋炎是最常见的并发症。两组的满意度水平无差异，两组中均无患者希望接受另一种手术。炎症性肠病问卷的总分或任何分类得分均无差异。
患者对这两种手术的满意度同样高。接受回肠储袋肛管吻合术的患者可预期较高的满意度和良好的生活质量。然而，选择回肠造口术的有知识的患者也能获得相同的生活质量，且没有盆腔储袋相关的较高并发症发生率。
