背景:对于因家族性腺瘤性息肉病(FAP)或溃疡性结肠炎(UC)而需要恢复性直肠结肠切除术的患者,回肠J袋肛门吻合术(J-IPAA)是标准方法。为了避免J-tip泄漏的风险,我们用D袋肛门吻合术(D-IPAA)改良了J袋,旨在消除回肠残端。我们研究的目的是评估可行性,D-IPAA的安全性和中期功能结局。
方法:回顾性比较D-IPAA和J-IPAA结构在恢复性直肠结肠切除术后。收集2014年10月至2018年3月记录手术时间的临床资料,袋施工时间,小袋体积,术中估计的失血量,并发症发生率,再入院和累计住院时间。在最后一次访问中,使用WexnerClevelandClinicScore以及克利夫兰全球生活质量(CGQL)量表评估了连续性。
结果:共有97例FAP(n=28)和UC(n=69)患者在直肠结肠切除术后出现J-IPAA(n=54)或D-IPAA(n=43)。患者匹配良好,在J和D组之间的术中变量没有差异。D袋的构造时间比标准J袋的构造时间短。两组间主要或次要并发症无差异。每组均出现小袋渗漏:J-IPAA组的J尖端渗漏引起的皮肤瘘和D-IPAA组的小袋阴道瘘。两组的临床结果(排便次数)相等,每组的Wexner评分在2.5年内显着改善,术后CGQL改善。
结论:对于UC和FAP患者,D型囊袋结构是安全可行的,中期功能转归良好,有可能降低囊袋渗漏的风险。
BACKGROUND: Ileal J-pouch anal anastomosis (J-IPAA) is the standard approach for patients requiring restorative proctocolectomy due to familial adenomatous polyposis (FAP) or ulcerative colitis (UC). To obviate the risk of a J-tip leak, we modified the J-pouch with a D-pouch anal anastomosis (D-IPAA) designed to eliminate the ileal stump. The aim of our study was to evaluate the feasibility, safety and medium-term functional outcomes of D-IPAA.
METHODS: A retrospective comparison was made between D-IPAA and J-IPAA constructions after a restorative proctocolectomy. Clinical data were collated between October 2014-March 2018 recording operation duration, pouch construction time, pouch volume, intraoperative estimated blood loss, complication rates, readmissions and cumulative length of hospitalization. Continence was assessed at the final visit with the Wexner Cleveland Clinic Score along with the Cleveland Global Quality of Life (CGQL) scale.
RESULTS: A total of 97 patients with FAP (n = 28) and UC (n = 69) who had J-IPAA (n = 54) or D-IPAA (n = 43) after proctocolectomy were identified. Patients were well matched with no differences noted in the intraoperative variables between the J- and D-pouch groups. The D-pouch construction time was shorter than that for a standard J-pouch. There was no difference in major or minor complications between groups. A pouch leak developed in each group: a cutaneous fistula from J tip leak in the J-IPAA group and a pouch-vaginal fistula from the IPAA the D-IPAA group. Clinical outcomes (the number of bowel movements) were equivalent in the two groups with the Wexner score significantly improving within each group up to 2.5 years and with improvement in the CGQL after surgery.
CONCLUSIONS: The D-pouch construction is safe and feasible for patients with UC and FAP with good functional outcome over the medium term and the potential to reduce the risk of pouch leaks.