摘要
目的 探讨全大肠切除回肠贮袋肛管吻合术治疗溃疡性结肠炎 (UC)和家族性腺瘤性息肉病 (FAP)的远期疗效。方法 1985～ 2 0 0 2年间共对 6 1例患者行全结肠直肠切除回肠贮袋肛管吻合术 ,其中UC 2 5例、FAP 34例、其他 2例 ,应用S袋 2 5例、S J袋 13例、J袋 17例以及W袋 6例 ,术后随诊 1～ 18年、平均 8年 ,比较分析术后控便功能及并发症。结果 全部患者存活。并发症发生率为 16 % ( 10 / 6 1) ,其中UC患者 ( 2 4 % ,6 / 2 5 )高于FAP患者 ( 12 % ,4 / 34) ,W袋高于其他各袋 ,手法吻合 ( 2 0 % ,8/ 4 1)高于吻合器吻合 ( 10 % ,2 / 2 0 ) ,但差异均无显著性 (P >0 0 5 )。术后 2 4h大便次数平均为 4 2次。日间 84 % ( 4 3/ 5 1)、夜间 75 % ( 38/ 5 1)的患者排便能自控 ,6 % ( 3/ 5 1)的患者有明显的大便失禁。大部分患者对目前的生活质量表示满意。结论 全大肠切除回肠贮袋肛管吻合术治疗可维持UC与FAP患者肛管自控功能和可接受的大便次数 ,术后并发症较少 。
Objective To evaluate the prognosis of the total proctocolectomy and ileal pouch anal anastomosis (IPAA) for ulcerative colitis(UC) and familial adenomatous polyposis(FAP) Methods Sixty one patients with ulcer colitis or familial adenomatous polyposis were performed total proctocolectomy and ilealpouch anal anastomosis during 1985 to 2002 There are S type pouch 25 cases,S J type pouch 13 cases ,J type pouch 17 cases and W type pouch 6 cases The complication and function after the IPAA were also discussed Results No patient died after operation The total morbidity is 16%(10/61), the morbidity of group UC(6/25) is higher than FAP′s (4/34) The W type pouch′s morbidity is higher than other three types′, the operation with stapled technique is associated with fewer complication than hand sewn IPAA(2/20 vs 8/41),however,there is also no significant difference between them The number of stools per 24 hours is 4 2, the percent of the normal continence of daytime and nighttime is 84%(43/51) and 75%(38/51) respectively There′s only about 6%(3/51)patient with fecal incontinence The most patients are satisfied with IPAA Conclusion The proctocolectomy ileal pouch anal anastomosis for FAP and UC has few complication with accepted frequence and preserve a good anal function ,it is an ideal alternative approach
出处
《中华外科杂志》
CAS
CSCD
北大核心
2004年第14期861-863,共3页
Chinese Journal of Surgery
