全结直肠切除回肠贮袋肛管吻合手术治疗溃疡性结肠炎的临床评价  

Clinical evaluation of restorative proctocolectomy with ileal pouch-anal anastomosis for ulcerative colitis

作　　者：韩洪秋[1] 刘刚[1] 刘彤[1] 吕永成[1] 付强[1] 

机构地区：[1]天津医科大学总医院普通外科,300052

出　　处：《中华医学杂志》2011年第45期3205-3209,共5页National Medical Journal of China

基　　金：天津市卫生局科技基金（2010KZ114）

摘　　要：目的 评价全结直肠切除、回肠贮袋肛管吻合（RP-IPAA）手术治疗溃疡性结肠炎（UC）的临床效果和应用价值.方法 对1989至2010年原天津市滨江医院结直肠外科和天津医科大学总医院普通外科结直肠专业115例UC患者行RP-IPAA治疗,观察分析手术方式、并发症及疗效.回肠双腔造口还纳术后3个月和12个月,以24h和夜间便次及Kirwan分级评价术后肛门自制功能；Bristol粪便分类法评定粪便性状；克利夫兰生活质量量表（CCQL）进行手术前后生活质量评估对比.结果 115例患者围手术期无死亡,术后随访均1年以上.术后并发症发生率20.9％（24/115）,包括切口和（或）腹腔感染、贮袋吻合口漏和出血、贮袋阴道瘘、贮袋炎、残端直肠炎、泌尿系结石及男性性功能障碍.24h和夜间便次还纳术后12个月均优于3个月[（3.9±1.7）次比（6.1±2.6）次,（1.3±0.7）次比（2.8±1.8）次,均P＜0.05].肛门自制功能术后3个月和12个月比较,差异均无统计学意义[Ⅰ级：87.0％（100例）比92.2％（106例）,Ⅱ级：7.8％（9例）比4.3％（5例）,Ⅲ级：5.2％（6例）比3.5％（4例）,均P ＞0.05],疗效满意.CCQL法评价RP-IPAA手术前后生活质量,术后较术前明显改善（P＜0.05）.结论 RP-IPAA是UC外科治疗的首选术式,临床应用安全,疗效满意,生活质量明显改善.Objective To evaluate the clinical efficacies of restorative proctocolectomy with ileal pouch-anal anastomosis（RP-IPAA）for ulcerative colitis（UC）.Methods A total of 115 UC patients underwent the procedure of RP-IPAA during the period of 1989 to 2010.The data of surgical procedures,complications and long-term outcomes were collected.Stool frequency during the 24-hour period and the night were recorded at months 3 and 12 post-operation.Anal continence functions were evaluated by the Kirwan grading scale and the fecal characteristics identified by Bristol stool form scale.The patients＇ quality of life was objectively accessed by the Cleveland Global Quality of Life（CGQL）index.Results No perioperative death was reported.The mean follow-up period was for at least 12 months.The postoperative complication rate was 20.9%（24/115）,including infectious complications,wound infection and（or）abdominal abscess,anastomotic leak,pouch hemorrhage,pouch-vaginal fistula,pouchitis,terminal proctitis,urinary calculi and male sexual dysfunctions.Stool frequency per 24 hours and night was 〈 3 to 12 month post-operation（3.9 ± 1.7 vs 6.1 ± 2.6,1.3 ± 0.7 vs 2.8 ＋ 1.8,both P 〈 0.05）.No significantchanges in anal continence functions existed between the above two time points[Grade Ⅰ：87.0%（n =100）vs 92.2%（n =106）,Grade Ⅱ：7.8%（n =9）vs 4.3%（n =5）,Grade llⅢ：5.2%（n =6）vs 3.5%（n =4）,all P 〉0.05].The postoperative CGQL results showed a much better quality of life than preoperative one.Conclusion As the first-choice operation for UC,RP-IPAA is safe and it offers satisfactory long-term outcomes and improved quality of life.

关 键 词：结肠炎 溃疡性 生活质量 吻合术 外科 肛门功能 

分 类 号：R656[医药卫生—外科学]