背景:溃疡性结肠炎中IPAA的可用技术包括手工缝制,双订书钉,和单钉吻合。有争议,适应症,以及关于这些技术的不同结果。
目的:描述技术细节,适应症,3种特定类型的吻合术在恢复性直肠结肠切除术中的结局。
方法:根据系统评价和荟萃分析标准的首选报告项目,对PubMed数据库中的文章进行系统文献综述。
方法:描述3种不同类型吻合结果的研究,在手术期间,接受溃疡性结肠炎恢复性直肠结肠切除术的患者。
方法:IPAA技术。
方法:术后结果(吻合口漏,总并发症发生率,和袋功能)。
结果:最初包括21项研究:6项研究仅针对单钉IPAA,2只在双装订IPAA上,6项研究比较了单装订和双装订技术,6比较双订书钉和手工缝制IPAA,和1包括单钉到手工缝制的IPAA。根据作者的判断,增加了37项研究作为补充证据。在1990年至2015年之间,大多数研究与双装订IPAA有关,要么仅分析此技术的结果,要么将其与手缝技术进行比较。2015年后发表的研究主要与经肛门行IPAA直肠切除术有关,其中引入了单吻合术而不是双吻合术,一些研究比较了这两种技术。
结论:使用手工缝制IPAA技术的研究数量较少,作者自行判断添加的大量研究是本研究的局限性。
结论:如果对低位直肠发育不良或癌症进行粘膜切除术,则应考虑手工IPAA。可能,重新做手术。双钉IPAA因其简单性和保留肛门过渡区的优点而被更广泛地采用,并发症较低,并具有足够的袋功能。单钉IPAA提供了更自然的设计,是可行的,与双吻合术相比,与合理的结局相关。观看研讨会的视频。
BACKGROUND: Available techniques for IPAA in ulcerative colitis include handsewn, double-stapled, and single-stapled anastomoses. There are controversies, indications, and different outcomes regarding these techniques.
OBJECTIVE: To describe technical details, indications, and outcomes of 3 specific types of anastomoses in restorative proctocolectomy.
METHODS: Systematic literature review for articles in the PubMed database according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses criteria.
METHODS: Studies describing outcomes of the 3 different types of anastomoses, during pouch surgery, in patients undergoing restorative proctocolectomy for ulcerative colitis.
METHODS: IPAA technique.
METHODS: Postoperative outcomes (anastomotic leaks, overall complication rates, and pouch function).
RESULTS: Twenty-one studies were initially included: 6 studies exclusively on single-stapled IPAA, 2 exclusively on double-stapled IPAA, 6 studies comparing single-stapled to double-stapled techniques, 6 comparing double-stapled to handsewn IPAA, and 1 comprising single-stapled to handsewn IPAA. Thirty-seven studies were added according to authors\' discretion as complementary evidence. Between 1990 and 2015, most studies were related to double-stapled IPAA, either only analyzing the results of this technique or comparing it with the handsewn technique. Studies published after 2015 were mostly related to transanal approaches to proctectomy for IPAA, in which a single-stapled anastomosis was introduced instead of the double-stapled anastomosis, with some studies comparing both techniques.
CONCLUSIONS: A low number of studies with handsewn IPAA technique and a large number of studies added at authors\' discretion were the limitations of this strudy.
CONCLUSIONS: Handsewn IPAA should be considered if a mucosectomy is performed for dysplasia or cancer in the low rectum or, possibly, for re-do surgery. Double-stapled IPAA has been more widely adopted for its simplicity and for the advantage of preserving the anal transition zone, having lower complications, and having adequate pouch function. The single-stapled IPAA offers a more natural design, is feasible, and is associated with reasonable outcomes compared to double-stapled anastomosis. See video from symposium.