Durno C, Sherman P, Harris K, Smith C, Dupuis A, Shandling B, Wesson D, Filler R, Superina R, Griffiths A
Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Ontario, Canada.
J Pediatr Gastroenterol Nutr. 1998 Nov;27(5):501-7. doi: 10.1097/00005176-199811000-00001.
To review the outcome after restorative proctocolectomy among children and adolescents with ulcerative colitis at a pediatric inflammatory bowel disease center.
The records of all patients with ulcerative colitis undergoing colectomy and ileoanal anastomosis at The Hospital for Sick Children, Toronto, Canada, were reviewed. Questionnaires concerning functional results were sent to patients with restored transanal defecation.
Seventy three patients (mean age, 13.2 years; range, 2.6-18.8 years) underwent ileoanal anastomosis (19 straight ileoanal anastomosis, 41 J pouch, 13 S pouch) between January 1980 and June 1995 and were observed 5.8+/-3.3 years. The ileoanal anastomosis is nonfunctional in 19 (26%) patients. Excision rates according to type of restorative procedure were J pouch, 7% (3 of 41); S pouch, 32% (4 of 13); and straight ileoanal anastomosis, 32% (6 of 19). Failure was usually attributable to intractable diarrhea among patients with straight ileoanal anastomosis but was caused by anastomotic leak or pelvic-perianal sepsis among patients with pouch procedures. Failure rates did not vary with age at ileoanal anastomosis. Among patients retaining ileoanal continuity, continence problems reported in the questionnaire were frequent and tended to be more extreme among younger patients. Overall, 90% of respondents reported satisfaction with the functional outcome of the restorative operation.
The success rate of the ileoanal anastomosis/J-pouch procedure is comparable to that in adult series. The ileoanal anastomosis/J-pouch procedure is the operation of choice for children and adolescents who want ileoanal continuity restored after colectomy for ulcerative colitis.
回顾一家儿科炎症性肠病中心中患有溃疡性结肠炎的儿童和青少年行保留肛门直肠切除术的术后结果。
回顾了加拿大多伦多病童医院所有接受结肠切除术和回肠肛管吻合术的溃疡性结肠炎患者的记录。向经肛门排便恢复正常的患者发送了关于功能结果的问卷。
1980年1月至1995年6月期间，73例患者（平均年龄13.2岁；范围2.6 - 18.8岁）接受了回肠肛管吻合术（19例直回肠肛管吻合术，41例J形贮袋，13例S形贮袋），并随访了5.8±3.3年。19例（26%）患者的回肠肛管吻合术无功能。根据保留肛门手术的类型，切除率分别为：J形贮袋7%（41例中的3例）；S形贮袋32%（13例中的4例）；直回肠肛管吻合术32%（19例中的6例）。失败通常归因于直回肠肛管吻合术患者的顽固性腹泻，但在贮袋手术患者中是由吻合口漏或盆腔 - 肛周感染引起的。失败率与回肠肛管吻合术时的年龄无关。在保留回肠肛管连续性的患者中，问卷中报告的控便问题很常见，且在年轻患者中往往更严重。总体而言，90%的受访者对保留肛门手术的功能结果表示满意。
回肠肛管吻合术/J形贮袋手术的成功率与成人系列相当。回肠肛管吻合术/J形贮袋手术是溃疡性结肠炎结肠切除术后希望恢复回肠肛管连续性的儿童和青少年的首选手术。
