回肠袋肛门吻合术治疗不确定性结肠炎的远期随访研究  

A long-term follow-up study of ileum pouch anal anastomosis in the treatment of indeterminate colitis

作　　者：曹羽[1] 龚航军[1] 韩刚[1] 张云[1] 张言言 张旭[1] CAO Yu;GONG Hang-jun;HAN Gang(Department of Gastrointestinal Surgery,Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine,Shanghai 201203,China)

机构地区：[1]上海中医药大学附属曙光医院胃肠外科,上海201203

出　　处：《临床和实验医学杂志》2021年第14期1535-1538,共4页Journal of Clinical and Experimental Medicine

基　　金：上海市卫生和计生委科研课题计划项目(编号:20154Y0140)。

摘　　要：目的探究回肠袋肛门吻合术对不确定性结肠炎的近期疗效及远期生存率的影响。方法回顾性分析2013年7月至2015年7月于上海中医药大学附属曙光医院确诊并治疗的不确定结肠炎82例,其中46例行回肠袋肛门吻合术治疗的患者作为研究组,36例行常规外科手术治疗的患者作为对照组。获取2组患者2年完整随访资料,收集其手术相关指标(手术时间、术中出血量、排气时间、导管置留时间、住院时间)、随访指标(术后并发症发生率、肛门功能、生活质量、总生存率);随访结束时根据患者生存情况将患者分为存活组和死亡组,比较2组患者临床资料并采用多因素分析其死亡危险因素。结果围手术期2组患者均无死亡;研究组手术时间、术中出血量、排气时间、导管置留时间、住院时间少于对照组,差异均有统计学意义(P<0.05)。研究组患者短期总有效率为86.96%,高于对照组(66.67%),差异有统计学意义(P<0.05)。研究组患者并发症发生率43.48%,低于对照组(66.67%),差异有统计学意义(P<0.05)。术后2组患者肛门功能及生活质量均逐渐改善,且研究组术后3、12个月24 h便次、夜间便次、克利夫兰生活质量量表(CGQL)评分、Kirwan分级均优于对照组,差异均有统计学意义(P<0.05)。研究组2年总生存率为84.78%,高于对照组(69.44%),差异有统计学意义(P<0.05)。重症型疾病、常规手术治疗方式是患者死亡危险因素(P<0.05),且手术方式相对危险比最大。结论回肠袋肛门吻合术对不确定性结肠炎治疗效果好。Objective To investigate short-term efficacy and long-term survival of indeterminate colitis patients with ileal pouch-anal anastomosis.Methods A total of 82 cases of indeterminate colitis patients treated in Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine from July 2013 to July 2015 were retrospectively analyzed.Among them,46 patients who received the ileal pouch-anal anastomosis were treated as the study group,and 36 patients who received the routine surgery as the control group.Two-year follow-up data,surgically related indicators(operative time,intraoperative blood loss,exhaust time,catheter placement time,length of hospital stay)and follow-up indicators(postoperative complication rate,anal function,quality of life,overall survival rate)were collected.Patients were divided into the survival group and the death group according to their prognosis.Then the risk factors of death were analyzed by multivariate analysis.Results There was no death in both groups during perioperative period.The operative time,intraoperative blood loss,exhaust time,catheter indwelling time and hospital stay in the study group were less than those in the control group(P<0.05).The total short-term effective rate of patients in the study group was 86.96%,which was higher than that of the control group(66.67%),and the difference was statistically significant(P<0.05).The incidence of complications in the study group was 43.48%,which was lower than that in the control group(66.67%),and the difference was statistically significant(P<0.05).The anus function and quality of life of the two groups were gradually improved after operation.The daily fecal frequency,nocturnal fecal frequency,quality of life in cleveland(CGOL)score and Kirwan gradi ng at postoperative 3mon and 12mon of the study group were all better than those of the control group(P<0.05).The 2-year overall survival rate of the study group was 84.78%,which was higher than that in the control group(69.44%),and the difference was statistically signif

关 键 词：不确定性结肠炎 回肠袋肛门吻合术 远期随访 

分 类 号：R656.9[医药卫生—外科学]