D型回肠贮袋在全结直肠切除回肠贮袋肛管吻合术中的应用价值  

Application value of ileal D-pouch in the total proctocolectomy with ileal pouch-anal anastomosis

作　　者：任相海[1] 周燕[1] 多乐[1] 江从庆[1] 吴云华[1] 秦前波[1] 钱群[1] 丁召[1] 

机构地区：[1]武汉大学中南医院结直肠肛门外科 湖北省肠病医学临床研究中心肠病湖北省重点实验室,430071

出　　处：《中华消化外科杂志》2016年第12期1189-1193,共5页Chinese Journal of Digestive Surgery

基　　金：湖北省科技计划项目（2015CFB408）

摘　　要：目的探讨D型回肠贮袋在全结直肠切除回肠贮袋肛管吻合术（TPC．IPAA）中的临床价值。方法采用回顾性横断面研究方法。收集2014年10月至2015年6月武汉大学中南医院收治的9例溃疡性结肠炎和8例家族性息肉病行TPC—IPAA患者的临床资料。术中构建D型回肠贮袋。观察指标：（1）术中及术后情况：手术情况，术中并发症，TPC—IPAA术后行回肠造口还纳术间隔时间，总手术时间，D型回肠贮袋构建时间，D型回肠贮袋容积，术中出血量，术后胃肠功能恢复时间，术后引流管拔除时间，术后并发症，术后住院时间。（2）随访情况。采用门诊和电话方式进行随访，了解患者术后恢复情况，评估术后胃肠道生命质量指数，术后Wexner失禁评分，24h和夜间排便次数，患者满意情况。随访时间截至2016年7月。正态分布的计量资料采用面x±s表示，偏态分布的计量资料以M（范围）表示。结果（1）术中及术后情况：17例患者均行TPC—IPAA，围术期无患者死亡。1例家族性息肉病患者术中发生肠穿孔，构建D型回肠贮袋后，手工行贮袋肛管吻合；其余患者未发生严重术中并发症。9例溃疡性结肠炎患者中，1例行三期手术，其余8例均行二期手术；9例于TPC—IPAA术后（177±38）d行回肠造口还纳术。8例家族性息肉病患者中，1例行一期手术，其余7例均行二期手术；7例于TPC-IPAA术后（158±45）d行回肠造口还纳术。17例患者总手术时间为（216±25）min，D型回肠贮袋构建时间为（18±4）min，D型回肠贮袋容积为（172±18）mL，术中出血量为（107±31）mL，术后胃肠功能恢复时间为（43±10）h，术后引流管拔除时间为（7．9±2．1）d。3例患者术后发生切口感染或脂肪液化，经对症处理后好转；1例溃疡性结肠炎患者术后5d发生不全性肠梗阻，予对症处理后好转。其余患者术后未发生并发症。17Objective To explore the clinical value of ileal D-pouch in the total proctocolectomy with ileal pouch-anal anastomosis （TPC-IPAA）. Methods The retrospective cross-sectional study was conducted. The clinical data of 9 patients with ulcerative colitis and 8 patients with familial polyposis who underwent TPC- IPAA at the Zhongnan Hospital of Wuhan University between October 2014 and June 2015 were collected. The ileal D-pouch was built during the operation. Observation indicators： （ 1 ） intra- and post-operative situations： surgical situation, intraoperative complications, interval time between TPC-IPAA and ileostomy, total operation time, build time and volume of ileal D-pouch, volume of intraoperative blood loss, recovery time of postoperative gastrointestinal function, time of postoperative drainage-tube removal, postoperative complications and duration of hospital stay, （2） follow-up situation. Follow-up was performed by outpatient examination and telephone interview up to July 2016. Follow-up included detecting the patients＇ recovery and evaluating gastrointestinal quality of life index （GIQLI）, postoperative Wexner incontinence score, frequency of defecation at 24 hours and at the night and patients＇ satisfaction. Measurement data with normal distribution were represented as x ± s. Measurement data with skewed distribution were represented as the M （range）. Results （1） Intra- and post-operative situations： 17 patients underwent TPC-IPAA, and no patient died during the perioperative period. One patient with familial polyposis had intraoperative intestinal perforation, and handsewn TPC-IPAA was conducted after building ileal D-pouch. And other patients didn＇t have postoperative complications. Of 9 patients with ulcerative colitis, 1 underwent three-stage operation and other 8 underwent two-stage operations. Nine patients underwent ileostomy at （ 177 ±38） days after TPC-IPAA. Of 8 patients with familial polyposis, 1 underwent one-stage operation and other 7 underwent two

关 键 词：溃疡性结肠炎 家族性息肉病 全结直肠切除回肠贮袋肛管吻合术 D型贮袋 

分 类 号：R656.9[医药卫生—外科学]