经肛回肠储袋肛管吻合术在全结直肠切除术患者中疗效 与术后功能观察研究  

Observational study on the therapeutic effect and postoperative function of patients treated by transanal ileal pouch anal anastomosis

作　　者：赵世栋 祝丽宇 侯森 刘凡[1] 尹慕军[1] 叶颖江[1] 申占龙[1] Zhao Shidong;Zhu Liyu;Hou Sen;Liu Fan;Yin Mujun;Ye Yingjiang;Shen Zhanlong(Department of Gastroenterological Surgery,Laboratory of Surgical Oncology,Laboratory of General Surgery,Beijing Key Laboratory of Colorectal Cancer Diagnosis and Treatment Research,Peking University People′s Hospital,Beijing 100044,China)

机构地区：[1]北京大学人民医院胃肠外科,北京大学人民医院外科肿瘤研究室,北京市结直肠癌诊疗研究重点实验室,100044

出　　处：《中华结直肠疾病电子杂志》2021年第4期418-423,共6页Chinese Journal of Colorectal Diseases(Electronic Edition)

基　　金：国家自然科学基金面上项目(No.81972240)。

摘　　要：目的探索全结直肠切除患者接受经肛回肠储袋肛管吻合(ta-IPAA)的疗效与功能学预后情况。方法回顾性收集2016年1月至2020年12月北京大学人民医院胃肠外科11例接受ta-IPAA手术的溃疡性结肠炎(UC)或家族性腺瘤性息肉病(FAP)患者,采用CGQL量表评估生活质量,LARS量表评估排便功能,IPSS评分评估排尿功能,IIEF-5及FSFI评分分别评估男性及女性的性功能,并分析其手术相关资料。结果本中心ta-IPAA手术时间为(324.55±97.51)min,术中出血量(307.27±272.91)mL,术后住院时间为11~43天(中位时间15天)。术后ta-IPAA组共有6例患者发生11例次并发症,包括2例Clavien-Dindo分级3级及以上。术后生活质量评分CGQL为0.76±0.14。排便功能方面,6例患者无LARS,2例轻度LARS,1例重度LARS。排尿功能方面,1例患者术后IPSS评分为重度症状,8例患者为无症状或轻度症状。性功能方面7例男性,1例术前即没有性生活,5例勃起功能正常,1例重度勃起功能障碍。2例女性近4周均无性生活,无法进行FSFI评分。结论本单位的患者接受ta-IPAA手术术后功能恢复较为良好,术后排便、排尿和性功能尚可,但术后并发症发生比例较高,安全性有待进一步提高。采取经腹和经肛联合手术,有助于缩短手术时间,降低单纯经腹低位直肠游离的手术难度,在UC、FAP等需要进行全结直肠切除疾病的外科治疗中具有一定的应用前景。Objective To summarize the curative effect and functional outcome of patient undergoing transanal ileal pouch anal anastomosis(ta-IPAA).Methods Eleven patients suffering from ulcerative colitis(UC)or familial adenomatous polyposis(FAP)at Department of Gastroenterological Surgery,Peking University People's Hospital from January 2016 to December 2020 were retrospectively collected.CGQL scale was used to assess quality of life,LARS scale were used to evaluate anal function,IPSS score was used to evaluate urinary function,IIEF-5 and FSFI score were used to evaluate male and female sexual function,respectively.And we analyzed the data related to the operation.Results The operative time of ta-IPAA in our center was(324.55±97.51)min,the intraoperative blood loss was(307.27±272.91)mL,and the postoperative hospital stay was 11~43 days(median time was 15 days).A total of eleven complications occurred in six patients in the ta-IPAA group after surgery,including two patients with ClavienDindo grade three or above.The postoperative quality of life score CGQL was 0.76±0.14.In terms of defecation function,six patients had no LARS,two had mild LARS and one had severe LARS.In terms of urinary function,IPSS score of one patient was severe,and eight patients were asymptomatic or mild.In terms of sexual function,seven cases were male,one case had no sexual life before surgery,five cases had normal erectile function,and one case had severe erectile dysfunction.Two women had no sex life for nearly 4 weeks and could not be evaluated by FSFI score.Conclusion Patients in our unit have good functional recovery after ta-IPAA surgery,and postoperative defecation,urination and sexual function are of good level.But the incidence of postoperative complications is high,and the safety of the operation needs to be further improved.Combined transabdominal and transanal surgery is helpful to shorten the operation time and reduce the difficulty of simple transabdominal low rectal separation,which has a certain application prospect in the surgical

关 键 词：结肠炎 溃疡性 全结直肠切除术 经肛回肠储袋肛管吻合 术后功能 

分 类 号：R735.34[医药卫生—肿瘤]