全结直肠切除回肠贮袋肛管吻合术治疗溃疡性结肠炎的并发症分析  

Analysis of complications of total proctocolectomy with ileal pouch-anal anastomosis in treatment of ulcerative colitis

作　　者：梁中林[1] 朱怡莲 傅佶泓[1] 陈卫[1] 杜鹏[1] 崔龙[1] 

机构地区：[1]上海交通大学医学院附属新华医院结直肠外科,200092

出　　处：《中华消化外科杂志》2016年第12期1182-1188,共7页Chinese Journal of Digestive Surgery

基　　金：国家自然科学基金（81570474）

摘　　要：目的分析全结直肠切除回肠贮袋肛管吻合术（TPC—IPAA）治疗重度或难治性溃疡性结肠炎的并发症发生情况。方法采用回顾性横断面研究方法。收集2008年2月至2015年10月上海交通大学医学院附属新华医院收治的67例行TPC—IPAA的重度或难治性溃疡性结肠炎患者的临床资料。采用开腹和腹腔镜辅助手术方式行TPC—IPAA，根据患者病情行二期或三期手术。观察指标：（1）治疗及随访情况。（2）TPC—IPAA术后近期并发症发生情况。（3）TPC—IPAA术后远期并发症发生情况。采用电话和门诊方式进行随访，了解患者术后生命质量和并发症发生情况。随访时间截至2016年7月。偏态分布的计量资料以M（范围）表示。手术前后患者生命质量评分比较，采用成对t检验。结果（1）治疗及随访情况：67例患者顺利完成手术，其中二期手术45例，三期手术22例。开腹手术37例，腹腔镜手术30例。术后平均日排便次数为5．6次／d。67例患者平均术前生命质量评分为0．47，术后生命质量评分为0．67，手术前后比较，差异有统计学意义（t=-4．80，P〈0．05）。67例患者均获得随访，中位随访时间为4．6年（1．0—8．4年）。（2）TPC—IPAA术后近期并发症发生情况：67例患者中，10例发生近期并发症（部分患者发生多种并发症）。1例患者发生骶前脓肿继发窦道形成，经局部肠镜下切开窦道治疗后痊愈。5例患者发生贮袋手术吻合口相关并发症，包括1例贮袋肛管吻合口瘘合并骶前脓肿行引流术联合回肠造口术，暂未行造口回纳；2例贮袋顶端瘘，行修补术后好转；2例贮袋阴道瘘，其中1例行贮袋残端阴道瘘切除，游离大网膜带血管蒂填塞在贮袋残端与后穹隆间，同时行回肠临时性转流，获得痊愈；1例患者前后2次经肛推移瓣阴道瘘修补术，虽临床症状缓解，但造影检查证实瘘口尚�Objective To analyze the complications of total proetocolectomy with ileal pouch-anal anastomosis （TPC-IPAA） in treatment of severe or refractory ulcerative colitis （UC）. Methods The retrospective cross-sectional study was conducted. The clinical data of 67 patients with severe or refractory UC who underwent TPC-IPAA in the Xinhua Hospital Affiliated to Shanghai Jiaotong University from February 2008 to October 2015 were collected. All the patients received open and laparoscopy-assisted TPC-IPAA, and two-stage or three-stage surgery was performed according to the patients＇ conditions. Observation indicators： （1） treatment and follow-up situations, （ 2 ） short-term complications after TPC-IPAA, （ 3 ） long-term complications after TPC-IPAA. The follow-up using telephone interview and outpatient examination was performed to detect the quality of postoperative life in patients and occurrence of complications up to July 2016. Measurement data with skewed distribution were described as M （range）. The comparison of quality of pre- and post-operative life in patients was done using the paired t test. Results （1） Treatment and follow-up situations： all the 67 patients received successful surgery, including 45 with two-stage surgery and 22 with three-stage surgery. Thirty-seven patients underwent open surgery and 30 underwent laparoscopic surgery. The average frequency of postoperative daily defecation, average scores of quality of pre- and post-operative lifes were 5.6, 0.47 and 0.67, respectively, with a statistically significant difference between preoperative indicators and postoperative indicators （t = - 4. 80, P 〈 0.05 ）. All the 67 patients were followed up for a median time of 4.6 years （ range, 1.0-8.4 years）. （2） Short-term complications after TPC-IPAA： Of 67 patients, 10 had short-term complications （some patients with multiple complications）. One patient was complicated with presacral abscess secondary to sinus formation and then was cured by topical incisio

关 键 词：溃疡性结肠炎 全结直肠切除回肠贮袋肛管吻合术 并发症 治疗 

分 类 号：R656[医药卫生—外科学]