腹腔镜下全结直肠切除、回肠储袋肛管吻合术治疗溃疡性结肠炎38例临床疗效分析  

Laparoscopic restorative proctocolectomy and ileal pouch anal anastomosis for ulcerative colitis: An analysis of clinical outcomes in 38 patients

作　　者：龚剑峰[1] 韦瑶[1] 顾立立[1] 郭振[1] 李毅[1] 张腾辉[1] 杨建波[1] 李宁[1] 朱维铭[1] 黎介寿[1] 

机构地区：[1]南京军区南京总医院普通外科,江苏南京21000

出　　处：《中国实用外科杂志》2016年第4期425-429,共5页Chinese Journal of Practical Surgery

摘　　要：目的 探讨腹腔镜下行全结直肠切除、回肠储袋肛管吻合术（IPAA）治疗溃疡性结肠炎（UC）的临床疗效。方法 回顾性分析南京军区南京总医院普通外科2014年1月至2015年9月行腹腔镜下IPAA治疗的38例UC病人的术中和术后临床资料,探讨该术式的技术要点及治疗效果。结果 38例病人均成功实施IPAA,34例病人实施腹腔镜下二期手术,4例病人实施三期手术,其中2例在第二期时中转开腹。22例为激素或挽救治疗失败的重症UC病人。手术中位时间为340（210~470）min。术后1例病人发生储袋肛管吻合口瘘,1例发生储袋顶端瘘,均经保守治疗治愈。术后3个月时随访病人平均排便次数为（4.75±1.24）次/d,克利夫兰总体生活质量评价（CGQL）为0.85±0.08。结论 采用腹腔镜技术行IPAA治疗UC安全可行,术后病人排便功能及生活质量满意。部分重度活动期UC病人也可实施二期手术。Objective To investigate the feasibility and outcome of laparoscopic restorative proctocolectomy and ileal pouch anal anastomosis （IPAA） for ulcerative colitis （UC）. Methods The clinical data of 38 patients undergoing laparoscopic IPAA in Department of General Surgery, the General Hospital of Nanjing Military Command of PLA from January 2014 to September 2015 were analyzed retrospectively, and technical notes were summarized. Results Laparoscopic IPAA was performed in 34 patients with two-stage surgery , 4 patients with three-stage surgery, and 2 patients had conversion. Twenty-two patients had acute severe UC with intravenous steroid or salvage therapy failure. Median operation time was 340 （210--470） min. Two fistulas occurred after surgery, one at pouch-anal anastomosis and one at the tip of the pouch. Both were successfully treated non-operatively. Defecation frequency 3 months after surgery was 4.75 ± 1.24 times per day. The mean Cleveland Global Quality of Life was 0.85 ± 0.08. Conclusion Laparoscopic IPAA for UC is safe and feasible, and postoperative defecation and quality of life are satisfactory. A two-stage surgery is suitable for selected patients with acute severe UC.

关 键 词：腹腔镜 溃疡性结肠炎 回肠储袋肛管吻合术 

分 类 号：R6[医药卫生—外科学]