背景:溃疡性结肠炎(UC)患者的直肠残余炎症可能影响回肠袋-肛门吻合术(IPAA)的术后结局。我们旨在确定IPAA期间吻合口区的炎症程度,并研究直肠炎对术后并发症和长期结局的影响。
方法:这项回顾性病例对照研究包括了33例原发性IPAAUC患者。吻合口区炎症的组织病理学程度分为三个阶段,即无直肠炎(“NOP”),轻度至中度直肠炎(“MIP”),和严重直肠炎(“SEP”)。术前危险因素,30天发病率,并对随访数据进行评估.在囊失效的情况下进行Kaplan-Meier分析。
结果:直肠炎的患病率很高(MIP40.4%,和SEP42.8%)。随访期间,在SEP中,并发症的发生率最高:导致再次干预(n=40;28.2%,p=0.017),囊炎(n=36;25.2%,p<0.01),和囊失效(n=32;22.4%,p=0.032)。在NOP中,囊失效的时间间隔为5.0(4.0-6.9)年,SEP中的1.2(0.5-2.3)年(p=0.036)。ASA3,囊炎,囊袋瘘是囊袋衰竭的独立危险因素。
结论:IPAA时的直肠炎很常见。高度的炎症与不良的长期结局有关,随着时间的推移而下降的影响。此外,更高程度的直肠炎导致更早的囊衰竭。
BACKGROUND: Inflammation of the rectal remnant may affect the postoperative outcome of ileal pouch-anal anastomosis (IPAA) in patients with ulcerative colitis (UC). We aimed to determine the extent of inflammation in the anastomotic area during IPAA and to investigate the impact of proctitis on postoperative complications and long-term outcomes.
METHODS: Three hundred thirty-four UC patients with primary IPAA were included in this retrospective
case-control study. The histopathologic degree of inflammation in the anastomotic area was graded into three stages of no proctitis (\"NOP\"), mild to medium proctitis (\"MIP\"), and severe proctitis (\"SEP\"). Preoperative risk factors, 30-day morbidity, and follow-up data were assessed. Kaplan-Meier analysis was performed in the event of pouch failure.
RESULTS: The prevalence of proctitis was high (MIP 40.4%, and SEP 42.8%). During follow-up, the incidence of complications was highest among SEP: resulting in re-intervention (n = 40; 28.2%, p = 0.017), pouchitis (n = 36; 25.2%, p < 0.01), and pouch failure (n = 32; 22.4%, p = 0.032). The time interval to pouch failure was 5.0 (4.0-6.9) years among NOP, and 1.2 (0.5-2.3) years in SEP (p = 0.036). ASA 3, pouchitis, and pouch fistula were independent risk factors for pouch failure.
CONCLUSIONS: Proctitis at the time of IPAA is common. A high degree of inflammation is associated with poor long-term outcomes, an effect that declines over time. In addition, a higher degree of proctitis leads to earlier pouch failure.