双吻合器法改进回肠贮袋肛管吻合术后肛门功能的研究  

Study of anal function after ileal pouch anal anastomosis with modified double-stapled mucosectomy

作　　者：张志勇 韩意[2] 林谋斌[2] 何永刚[2] 张浩波[2] 陆兴生[2] 吕克之[2] 尹路[2] 

机构地区：[1]诸暨市人民医院肛肠外科,诸暨311899 [2]上海交通大学医学院附属瑞金医院普外科,上海200025

出　　处：《国际外科学杂志》2012年第8期518-521,共4页International Journal of Surgery

摘　　要：目的探讨应用双吻合器法改进传统的回肠贮袋肛管吻合术，术后长期的肛门功能情况。方法回顾性分析2002年1月-2011年3月完成的45例双吻合器法回肠贮袋肛管吻合术患者的临床资料，其中家族性息肉病患者16例和溃疡性结肠炎患者29例。应用Kirwan评分及Oresland贮袋特异性功能评分评估术后远期肛门功能。结果平均随访65个月（12～110个月）后，2例恶性家族性息肉病患者死亡，其余患者中2例m现不典型息肉增生，4例患者出现轻到中度的吻合口狭窄，1例患者出现严重的吻合口狭窄，需再次手术干预，16例患者出现贮袋炎的临床症状。本组45例患者中无肛门失禁发生，术后1年、2．5年、5年的中位Oresland贮袋特异性功能评分分别为6分、3分和2分。结论应用双吻合器法改进回肠贮袋肛管吻合术后大便控制能力满意，无肛门失禁发生。Objective To evaluate the long-term functional outcome after ileal pouch anal anastomosis with modified double-stapled technique. Methods From January 2002 to March 2011, forty-five patients underwent ileal pouch anal anastomosis with modified double-stapled technique. The clinical data of these patients were reviewed. The postoperative anal function was assessed by Kirwan classification and Oresland pouch-specific function score. Results During the median follow-up of 65 months, 2 patients with malignant adenomatous polyps died, 2 patients were diagnosed dysplasia by biopsy,4 patients developed mild to moderate anastomotic narrowing, 1 patient developed persistent anastomotic stricture needing surgical intervention, 16 patients developed at least 1 episode of pouchitis. There was no incontinence in these patients, and the median functional Oresland score was 6, 3 and 2 after 1 year, 2.5 years and 5 years respectively. Conclusion The functional results of ileal pouch anal anastomosis with modified double-stapled technique are promising, with no ineontinence in our patients.

关 键 词：回肠贮袋肛管吻合术 吻合器法黏膜剥除术 结肠炎 溃疡性 腺瘤息肉病 结肠 肛门功能 

分 类 号：R735.37[医药卫生—肿瘤]