腹腔镜辅助下全大肠切除、回肠储袋与直肠肌管吻合术治疗家族性腺瘤性息肉病

目的 探讨腹腔镜辅助下全大肠切除、回肠储袋与直肠肌管吻合术在治疗家族性腺瘤性息肉病(familial adenomatous polyposis,FAP)中的价值.方法 回顾性统计分析7例FAP患者行腹腔镜辅助下全大肠切除、回肠储袋与直肠肌管吻合术的手术、术后恢复情况及随访资料,并与同期开腹手术患者相比较.结果 腹腔镜手术患者手术切口平均长度为4.32 cm,明显短于开腹手术,差异有统计学意义;术后排气时间平均为1.45 d,短于开腹患者,两组间差异无统计学意义;住院时间平均为11.95d,明显短于开腹手术患者,差异有统计学意义.术后6个月随访资料显示回肠储袋与直肠肌管吻合术安全可靠,较回肠储袋肛管吻合术后患者排便次数明显减少,肛管静息压和最大收缩压明显增高.结论 与原有回肠储袋肛管吻合术相比,腹腔镜辅助全大肠切除、回肠储袋直肠肌管吻合术不仅手术创伤小,手术方式简单,手术难度低,而且减少了可能发生的盆底肌肉和肛门括约肌损伤,更好地保留患者控排便功能.     

回肠储袋与直肠肌管吻合术治疗家族性腺瘤性息肉病15例分析

目的探讨回肠储袋与直肠肌管吻合术在治疗家族性腺瘤性息肉病中的价值。方法回顾性分析15例FAP患者行全大肠切除回肠储袋与肛管或直肠肌管吻合术的手术方式、并发症以及结肠镜、肛肠测压等随访资料。结果回肠储袋与直肠肌管吻合术安全可靠,无严重并发症,较回肠储袋肛管吻合术术后排便频率明显降低,肛管静息压力和最大收缩压力明显增高,肛管长度明显延长。结论与传统的回肠储袋肛管吻合术相比,回肠储袋与直肠肌管吻合术简化了手术,减少了盆底肌肉和肛门括约肌损伤,保留了更多控便功能。     

腹腔镜辅助全结直肠切除术治疗家族性腺瘤性息肉病9例报告

目的:探讨腹腔镜辅助全结直肠切除术治疗家族性腺瘤性息肉病(familial adenomatous polyposis,FAP)的安全性、可行性及应用价值。方法:回顾分析为9例FAP患者行腹腔镜辅助全结直肠切除术的临床资料,总结手术经验,并观察其安全性、术后患者康复情况及短期随访结果。同期5例开腹全结直肠切除术患者作为对照组。结果:9例患者均顺利完成手术,无中转开腹及术中并发症发生;手术时间160～250 min,平均195.56 min,略长于开腹组;术中出血量50～300 ml,平均138.89 ml,与开腹组相比,差异无统计学意义;切口长度4～6 cm,平均5.11 cm,术后肠功能恢复时间2～4 d,平均2.78 d,显著优于开腹组;术后住院7～20 d,平均12.11 d,与开腹组差异无统计学意义。术后1例低位吻合患者出现吻合口漏,余均无严重并发症发生。随访7～40个月,无肿瘤局部复发、远处转移及死亡。结论:具有丰富的腹腔镜及开腹手术经验的术者行腹腔镜辅助全结直肠切除术安全、可行,患者创伤小,康复快,近期效果良好,但尚需进一步的病例积累及随机对照研究。     

家族性腺瘤性息肉病

家族性腺瘤性息肉病晏仲舒，廖国庆家族性腺瘤性息肉病（ＦＡＰ）为常染色体显性遗传病，外显率达９０％以上［１］，按出生人口计其发病率约为１／５０００～１／１７０００［１，２］，如不治疗，最终１００％会发展成大肠癌。虽然由ＦＡＰ所致的在肠癌仅占１％～５％，...     

全结肠切除回肠"S"型储袋肛管吻合术治疗家族性腺瘤性息肉病

目的:探讨全结肠切除回肠“S“型储袋肛管吻合术治疗FAP的效果.方法:回顾分析1995至2005年进行的33例FAP全结肠切除术,对治疗效果进行分析.结果:33例患者中良性21例,癌变12例.全部患者均施行了全结肠切除,27例回肠“S“型储袋肛管吻合术,6例永久性回肠造口术; 手术后无严重并发症发生.33例均得到随访1～10年, 5例癌变病人因肿瘤复发、肝转移死亡.余者术后生存质量满意,排便功能良好. 结论:全结肠切除回肠“S“型储袋肛管吻合术治疗FAP息肉切除彻底、术后控便能力理想,该术式是治疗FAP较为理想的手术方式.     

腹腔镜结直肠次全切除治疗轻中度家族性腺瘤性息肉病

由于家族性腺瘤性息肉病（FAP）患者结直肠恶变的风险大．保留直肠或部分结肠二期手术切除率高．临床上倾向于行全结直肠切除术,并在防止息肉复发、癌变上体现出良好的治疗效果。但患者术后的生活质量较低,术后水电解紊乱、排粪失禁、反复腹泻或肛门湿疹等并发症时有发生。而且FAP也可表现为结肠外病变．结直肠全切除并不能防止结肠外病变的发生。因此．部分学者认为。保留直肠或部分结肠手术（结直肠次全切除）对轻中度病例也是可以选择的术式．在严密随访下．能改善术后排粪情况,提高生活质量．如有癌变再二期行残留结直肠切除术。浙江中医药大学第一临床医学院自2006年9月起．对轻中度FAP患者实施腹腔镜结直肠次全切除术,至2010年7月．成功实施4例,临床效果满意。     

腹腔镜手术治疗家族性腺瘤性息肉病临床分析

目的探讨家族性腺瘤性息肉病(familial adenomatous polyposis,FAP)的微创外科治疗疗效与安全。 方法回顾性分析2010年2月至2017年3月于北京协和医院行腹腔镜手术治疗的16例FAP患者的病例资料。 结果16例患者均完成腹腔镜手术,其中行全结直肠切除、回肠储袋肛管吻合术6例,全结肠直肠切除、回肠端式造口5例,全结肠切除、回肠直肠吻合术5例;无中转开腹,手术时间(227.9±52.7)min,平均术中出血量(98.1±90.7)ml。5例(31.2%)发生腺瘤癌变,4例(25.0%)伴高级别上皮内瘤变。14例患者获得长期随访,其中4例患者残余直肠新发息肉、3例患者术后发生腹腔硬纤维瘤。1例FAP合并肠癌患者术后1.5年因肝转移死亡。 结论腹腔镜手术治疗FAP安全可行;FAP患者术后需定期复查。     

家族性腺瘤性息肉病

温习近十年来有关家族性腺瘤性息肉病的文献 ,结合笔者在临床上对此病诊断和治疗的经验 ,对该病的遗传、病理及临床特点 ,诊断和治疗方面的进展作一综述 ,以增加对此病的认识 ,有助于正确处理家族性腺瘤性息肉病。     

Rectal eversion and double-stapled ileal pouch anal anastomosis in familial adenomatous polyposis syndrome

INTRODUCTION

Surgery is the only treatment option for familial adenomatous polyposis (FAP). Aim of surgery in FAP is to minimize colorectal cancer risk without need for permanent stoma. There are especially two operation options; Total colectomy with ileorectal anastomosis (IRA) and total proctocolectomy with ileo-pouch anal anastomosis (IPAA). We report here a patient with FAP who had resection via rectal eversion just over the dentate line under direct visualization and ileoanal-J pouch anastomosis by double-stapler technique.

PRESENTATION OF CASE

A 40 yr. old female patient with FAP underwent surgery. Firstly, colon and the rectum mobilized completely, and then from the 10 cm. proximal to the ileo-caecal valve to the recto-sigmoid junction total colectomy was performed. Rectum was everted by a grasping forceps which was introduced through the anus and then resection was performed by a linear stapler just over the dentate line. A stapled J-shaped ileal reservoir construction followed by intraluminal stapler-facilitated ileoanal anastomosis. Follow up at six months anal sphincter function was found normal.

DISCUSSION

There is only surgical management option for FAP patients up to now. Total colectomy with IRA and restorative proctocolectomy with IPAA is surgical options for FAP patients that avoid the need for a permanent stoma. Anorectal eversion may be used in the surgical treatment of FAP, chronic ulcerative colitis and early stage distal rectal cancer patients.

CONCLUSION

J-pouch ileoanal anastomosis can safely be performed by rectal eversion and double stapler technique in FAP patients.     

全大肠切除回肠贮袋肛管吻合术治疗家族性腺瘤性息肉病45例分析

目的探讨全大肠切除回肠贮袋肛管吻合术在治疗家族性腺瘤性息肉病(familial adenomatous polyposis,FAP)中的价值。方法回顾性分析1995—2005年45例FAP患者行全大肠切除回肠贮袋肛管吻合术的手术方式、并发症以及结肠镜、肛肠测压等随访资料。结果45例中发生吻合口漏1例;术后平均排便频率:3个月内每日9次,6个月后每日5次,12个月后每日4次;术后平均肛管慢波静息压为5 cm H_2O,频率为13次/min,肛管收缩压平均180 cm H_2O。37例术后结肠镜随访发现,14例有贮袋息肉(14/37,38%);4例术后发生小肠系膜硬纤维瘤。结论全大肠切除回肠贮袋肛管吻合术是FAP理想的外科手术方式,回肠"J"型贮袋患者控便功能良好,术后应密切随访,预防发生大肠外肿瘤。     

腹腔镜全结直肠切除并拖出式直肠黏膜剥离术治疗FAP及UC

目的探讨腹腔镜全结直肠切除并拖出式直肠黏膜剥离术治疗家族性腺瘤性息肉病(FAP)及溃疡性结肠炎(UC)的可行性及安全性。方法自2007年12月至2009年9月,应用腹腔镜全结直肠切除治疗FAP9例及UC4例,除2例因直肠癌变行回肠造口外,其余11例均在腹腔镜下游离全结直肠后,将直肠外翻拖出后行直肠黏膜剥离,再将回肠J型储袋与齿线行手工吻合。结果 13例手术均在腹腔镜辅助下成功完成,平均手术时间(248.8±27.8)min,平均出血量(61.0±27.7)ml,辅助切口平均长度(3.8±1.0)cm,术后2~3d排气。所有患者术后恢复顺利,无严重并发症。所有患者随访超过4个月,肛门功能恢复较满意。结论腹腔镜辅助全结直肠切除、拖出式直肠黏膜剥离并回肠储袋肛管吻合术是可行、安全及微创的,在保证对疾病治疗彻底性的同时,能取得较满意的近期效果。     

Laparoscopic restorative total proctocolectomy with ileal pouch anal anastomosis for familial adenomatous polyposis

BACKGROUND: Familial adenomatous polyposis is a hereditary disease characterized by the presence of thousands of colonic adenomas, which, if untreated, invariably undergo malignant transformation. Because this disease manifests at a young age, the laparoscopic approach to perform surgery would be desirable due to its cosmetic benefits. We describe our experience with this procedure and review the literature on the topic. METHODS: This is a case series of 15 patients who underwent restorative proctocolectomy with ileo-anal pouch anastomosis for familial adenomatous polyposis between 2000 and 2007. The salient operative steps are described. RESULTS: There were 9 males and 6 females, 32 to 52 years of age, with an average age of 44.8 years. The median body mass index was 21.5 (range, 17 to 28). Rectal cancer was already present in 4 patients at the time of diagnosis. The median operating time was 225 minutes. Mean blood loss was 60 mL, with none of the patients requiring perioperative blood transfusion. None of the surgeries required conversion to the open approach. Bowel function resumed on the second postoperative day in 12 patients and on the third postoperative day in 3 patients. The median hospital stay was 8 days. Postoperatively, there was no mortality and no serious morbidity. CONCLUSION: Laparoscopic restorative proctocolectomy with ileal pouch anal anastomosis is a feasible surgery for familial adenomatous polyposis, and considering its cosmetic benefit, is a desirable option for this group of predominantly young patients.     

腹腔镜全结肠切除术在家族性腺瘤性结肠息肉病及溃疡性结肠炎中的临床应用

目的:探讨腹腔镜全结肠切除术在家族性腺瘤性结肠息肉病(familial adenomatous polyposis,FAP)及溃疡性结肠炎(ulcerative colitis,UC)治疗中的应用价值。方法:回顾分析2009～2012年为12例患者行腹腔镜全结肠切除术(FAP患者7例,UC患者5例)及18例传统开腹全结(直)肠切除术(FAP患者7例,UC患者11例)的临床资料。结果:腹腔镜组在切口长度、术中出血量、术后止痛药使用量、术后排气时间、拔除导尿管时间、术后住院时间等方面优于开腹组,住院总花费明显高于传统开腹手术。结论:腹腔镜全结肠切除术用于FAP及UC安全、可行,与传统开腹手术相比,具有患者创伤小、康复快等优点,手术效果不亚于传统开腹手术,具有较高的临床应用价值。     

应用吻合器手术治疗家族性腺瘤样息肉病21例分析

目的探讨3种吻合器在治疗家族性腺瘤样息肉病的临床应用价值。方法回顾性分析华中科技大学同济医学院附属同济医院2000年1月至2005年12月间采用吻合器手术治疗家族性腺瘤样息肉病21例的临床资料。结果21例病人均采用3种吻合器手术,行全结肠切除、直肠超低位前切除、回肠J形贮袋肛管吻合术,并预防性回肠造口。全组无手术死亡病人、无吻合口瘘、盆腔脓肿、吻合口狭窄等严重并发症发生。1例病人发生贮袋粘连,在直肠镜下分离治愈;2例吻合口附近发现息肉经内镜电灼切除。全组病人排便功能满意,排便次数控制在每天2～5次。结论采用3种吻合器进行结肠切除、直肠超低位前切除、回肠贮袋与肛管吻合术,并预防性回肠造口,手术安全、简捷省时、术后并发症较少,应作为首选手术方式,手术后应进行长期随访,及时发现和处理复发息肉。     

Laparoscopic total proctocolectomy with ileal pouch anal anastomosis for ulcerative colitis and familial adenomatous polyposis: initial experience in Mexico

Background Since the introduction of laparoscopic colectomy in 1991, experience in laparoscopic bowel surgery has gradually increased. Several reports from specialized centers have demonstrated that laparoscopic colorectal resections are feasible and safe, providing an acceptable alternative to laparotomy for a variety of diseases. Some studies have shown the feasibility, safety, and good functional outcome of the minimally invasive procedures for ulcerative colitis (UC) and familial adenomatous polyposis (FAP). No known studies have investigated laparoscopic proctocolectomy in México. This report aims to describe the first laparoscopic proctocolectomies with ileal pouch anal anastomosis (IPAA) performed at the Instituto Nacional de Ciencias Medicas y Nutrición Salvador Zubirán (INCMNSZ). Methods All the patients in the authors’ institution who underwent a one- or two-stage laparoscopic total proctocolectomy with IPAA between June 2005 and December 2006 were included in the study. All the operations were performed by the same surgeon, who had already completed the learning curve for colorectal laparoscopic procedures. Results For the study, 10 patients underwent a laparoscopic proctocolectomy with IPAA by a single surgeon. Eight of the patients underwent a one-stage procedure, whereas two patients with severe colitis underwent a two-step procedure. All the cases were managed with a diverting loop ileostomy. Six patients underwent a standard double-stapled IPAA anastomosis, and two patients with FAP underwent a mucosectomy with a manual IPAA anastomosis. The mean operative time was 187 min, and the mean blood loss was 46 ml. There were two postoperative complications. One patient presented with an early small bowel obstruction due to an internal hernia, which required reoperation. The other complication was a wound infection. The mean return to oral intake was 1.5 days, and the mean length of hospital stay was 3.4 days. Conclusion Although this was not a comparative study and although sample size imposed limitations, with this preliminary data, we conclude that the laparoscopic approach to UC and FAP at our institution is safe, feasible, and effective. However, to achieve the benefits in postoperative outcome, this procedure should be performed only by experienced laparoscopic surgeons.