直肠手术各种储袋的应用与评价  

Application and evaluation of pouch configuration in ;rectal surgery

作　　者：傅传刚[1] 高显华[1] 

机构地区：[1]第二军医大学附属长海医院肛肠外科,上海200433

出　　处：《中华胃肠外科杂志》2014年第5期431-434,共4页Chinese Journal of Gastrointestinal Surgery

基　　金：国家自然科学基金（30973460,81272561）;国家自然科学基金青年科学基金（81201936）

摘　　要：结肠储袋能改善低位直肠切除保肛术后早期控制排粪功能障碍，但其对患者术后远期（2年以上）控制排粪功能方面不具有优势。同时，随着时间的延长，排空障碍的发生率将逐渐提高，很多患者出现排粪困难，需要长期应用栓剂和灌肠。而储袋的制作延长了手术时间，增加了治疗费用。所以，低位直肠切除术后结肠储袋的价值正在遭受质疑，它的应用也变得越来越少。在溃疡性结肠炎（UC）和家族性腺瘤性息肉病（FAP）行全结肠切除术后，如果行回肠储袋肛管吻合（IPAA），可通过增加新建直肠的容积并改变肠管的生理学动力，使排粪次数减少；且术后短期和长期控制排粪功能更好，生活质量更高。所以，IPAA是手术治疗UC和FAP的首选。Colonic pouch can improve fecal continence after low anterior resection in the short-term, but its superiority would disappear in the long-term （2 years after surgery）, since fecal continence improves gradually with time in the non-pouch group. Furthermore, the incidence of incomplete defecation increases gradually with time , and a lot of patients would have difficulty in defecation and require long-term use of suppositories and enemas. Pouch enforcement＆amp;nbsp;will result in prolonged operation time and increased treatment cost. Therefore, the value of colonic pouch in low rectal anastomosis is being questioned, and its application diminishes gradually. For patients with ulcerative colitis （UC） or familial adenomatous polyposis （FAP） after total colectomy, ileal pouch anal anastomosis （IPAA） can reduce fecal frequency and improve patients′ quality of life in both short-term and long-term, by increasing the volume of the neo-rectum and altering intestinal motility. For these reasons, IPAA is the first surgical choice for UC and FAP.

关 键 词：结肠储袋 回肠储袋肛管吻合 低位直肠切除术 直肠肿瘤 溃疡性结肠炎 家族性腺瘤性息肉病 

分 类 号：R657.1[医药卫生—外科学]