家族性腺瘤性息肉病的外科治疗

为了提高家族性腺瘤性息肉病（ＦＡＰ）的外科治疗效果，对１６例ＦＡＰ患者的外科治疗情况进行了回顾性总结。１６例中除１例行全结肠直肠切除、回肠造口外，其余１５例均行全结肠直肠切除、回肠贮袋肛管吻合术。贮袋式中Ｊ型３例、Ｈ型１例，Ｓ型１１例，术后全部患者获１～５年随访，随访结果表明，病人排便功能均较满意，其中以Ｓ型贮袋者为好。笔者认为全结肠直肠切除是治疗ＦＡＰ唯一彻底有效的方法，而回肠贮袋肛管吻合则是减少术后排便次数、提高术后生活质量的良好术式，并讨论了手术方式的选择、手术操作等     

回肠贮袋的作用是否能持久?

对于需行全结肠、直肠切除术的病人 ,回肠贮袋术可避免永久性的回肠造口。有报道贮袋功能的短期效果令人满意 ,但长期作用尚无法肯定 ,需长期随访观察。有研究认为贮袋术后控便功能的减退与年龄、贮袋炎、吻合口狭窄、括约肌功能失常、原发病及手术技巧有关。目前贮袋术后随访时间超过 10年以上的报道少见。ＢｕｌｌａｒｄＫＭ等对 1992年随访的 2 3 5例因炎性肠病 (溃疡性结肠炎、克罗恩病 )或ＦＡＰ行全结肠、直肠切除术、回肠贮袋术的病人再次进行排便功能的随访调查。其中有效的随访 15 4例 (60 % ) ,平均年龄 47(2 5 72 )岁 ,平均随访…     

全结肠切除直肠粘膜剥除肌鞘内回肠造袋拖出肛门吻合术

全结肠切除直肠粘膜剥除肌鞘内回肠造袋拖出肛门吻合术的主要适应证为溃疡性结肠炎（ＵＣ）和家族性腺瘤性息肉病（ＦＡＰ）〔１〕。在西方国家，ＵＣ发病率比我国高，对内科治疗无效的患者，本术式是最佳选择，自８０年代初期应用于临床后，已积累了较多经验。ＦＡＰ患者...     

J型回肠贮袋肛管吻合术在全结肠切除中的应用

目的：探讨全结肠切除术后J型回肠贮袋肛管吻合的价值。方法：对近5年16例全结肠切除病人应用J型回肠贮袋肛管肛管吻合术进行分析总结。结果：该术式并发症少,无一例回肠肛管吻合口瘘发生,肛门功能良好,无夜间漏便,大便次数平均3－5次／d,夜间0－1次,无贮袋炎发生,病人对生活质量感到满意。全组病人随访1－5年,无恶变发生。结论：全结肠切除J型回肠贮袋肛管吻合术能有效地预防吻合口瘘,贮袋炎,且肛门功能好,手术操作相对简便易行,只要指征选择适当,该术式是一种较为理想的手术方法。     

结直肠切除回肠贮袋手术的应用

结直肠切除回肠贮袋手术的应用广西医科大学第一附属医院大肠肛门病外科（５３００２７）高枫，唐宋江，陈利生在我国，随着家族性结肠息肉病（ＦＡＣ）及慢性溃疡性结肠炎（ＵＣ）的病例逐渐增多，外科治疗的地位日趋重要。因此，研究和开展根治性彻底、功能保存性满意的...     

全毕肠直肠切除回肠贮袋肛管吻合术的手术配合

全结肠直肠切除术适合于结肠多发性家庭性息肉病 ,溃疡性结肠炎非手术治疗无效 ,且直肠病变较轻者。以往在全结肠直肠切除后 ,行回肠造口 ,但永久性的回肠造口术后给病人带来诸多的不便 ,生活质量下降 ,病人要承受较大的精神压力及一定的社会压力。近年来 ,出现了多种全结肠直肠切除 ,回肠贮袋肛管吻合术式。自 1 994年以来 ,我院肛肠外科完成全结肠直肠切除 ,回肠贮袋肛管吻合术 2 0例 ,取得了满意效果。现就将手术配合体会介绍如下。1　临床资料　　本组 2 0例病人。男 1 8例、女 2例。年龄 1 5～61岁 ,平均年龄 32 .5岁。其中家庭性息肉…     

原发性末端回肠造口癌一例

患者男性,59岁,因末端回肠造口肿块伴出血3年于2012年4月14日入院。患者于1973年因“家族性息肉病（familial adenomatous polyposis,FAP）”行“结肠次全切除术”,术后困直肠息肉复发,又于1977年行“全结肠、肛门切除加末端回肠贮袋造口术”。     

203例直肠结肠切除后回肠贮袋肛管吻合术

直肠结肠切除回肠贮袋肛管吻合术(IPAA）现普遍被用来治疗溃疡性结肠炎和家族性腺瘤性息肉,从而代替全结肠直肠切除回肠造瘘。由于并发症发生率高和功能方面的问题．限制了一些外科医生的使用,且各种贮袋结构的潜在优点仍有争议,本对手术经验,尤其是手术并发症进行了总结,并比较不同贮袋结构的功能。     

回肠贮袋的选择(综合报道)

慢性溃疡性结肠炎及家族性腺癌样息肉病已公认为直肠结肠切除术的指征.虽然已有许多不同类型的贮袋设计,但迄今为止,尚无理想的构型,本篇综述了目前研究中的各种盆腔回肠贮袋的优缺点.     

全结肠切除三环型回肠贮袋加选择性截流术的疗效评价

目的探讨全结肠切除后三环型回肠贮袋肛管吻合加选择性截流术的价值和疗效。方法对10余年来20例全结直肠切除的患者应用三环型回肠贮袋加选择性截流术进行分析总结。结果该手术方法新颖，操作简单，并发症少，发生率为15％（3／20），由于存在一段逆蠕动肠管和多个环形肠管以及2cm左右的直肠移行带黏膜，故其术后控便功能好，至6个月时都能控制干便，其中正常控制的为80％（16／20），控制欠佳的为20％（4／20），无大便失禁；而稀便控制能力较差，至1年时仍有5％（1／20）的患者稀便失禁，无一例需插管排空，平均排便频率低于东方人群同类手术者。结论全结肠切除后三环型回肠贮袋肛管吻合加选择性截流术是一种简单、安全、并发症少、术后控便功能好的理想术式。     

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.     

The ileo-anal pouch procedure: Complications, quality of life, and long-term results

The ileo-anal pouch procedure: Complications, quality of life, and long-term results. Restorative proctocolectomy with construction of an ileal pouch-anal anastomosis (IPAA) has evolved as the surgical therapy of choice for patients with ulcerative colitis (UC) and patients with familial adenomatous polyposis (FAP). 662 patients (493 UC, 169 FAP) consecutively received IPAA. Marked differences were observed between UC and FAP patients regarding the rates of overall complications (33.1 % vs. 12.5 %), pouchitis (29 % vs. 2 %), and pouch extirpation (3.2 % vs. 0.6 %). Pouchitis occurred as primary (79 %) and secundary (21 %) form, with acute (67.2 %) or chronic (32.8 %) course. Each form and course required specific therapy. Chronic pouchitis implies the risk of malignant transformation of the pouch mucosa. Quality of life improves significantly after IPAA in patients with UC and is equal to that in normal individuals, in UC and FAP, if postoperative complications are either prevented or under control.     

Chemoradiotherapy followed by restorative proctocolectomy with partial intersphincteric resection for advanced rectal cancer associated with ulcerative colitis: report of a case

The role of restorative proctocolectomy with ileal J-pouch anal anastomosis (IPAA) is uncertain for patients with ulcerative colitis (UC), when advanced lower rectal cancer is diagnosed. We report what to our knowledge is the first documented case of successful preoperative chemoradiotherapy followed by IPAA with partial intersphincteric resection of advanced rectal cancer associated with UC. A 59-year-old woman with a 24-year history of extensive UC was found to have advanced rectal cancer located 2 cm from the anal verge. She underwent preoperative conventional chemoradiotherapy followed by restorative proctocolectomy with total mesorectal excision. The procedure included intersphincteric resection of one quadrant and construction of an IPAA with diverting ileostomy. The postoperative course was uneventful, and the ileostomy was closed 6 months after the initial surgery. The patient was doing well with good pouch function and no evidence of recurrent disease 1 year after her initial surgery.     

Functional outcome of stapled ileal pouch-anal canal anastomosis versus handsewn pouch-anal anastomosis

This study was conducted to determine whether stapled ileal pouch-anal canal anastomosis (IACA) preserving the anal transitional zone (ATZ) or hand-sewn ileal pouch-anal anastomosis with mucosectomy (IPAA) is more beneficial in achieving disease eradication and better postoperative function. IACA was performed in 10 patients with ulcerative colitis (UC) and 10 patients with familial adenomatous polyposis (FAP), 15 of whom were examined proctoscopically. IPAA was performed in 4 patients with UC and 8 patients with FAP. The mean maximum resting pressure (MRP) was 55 mmHg in the IACA group and 34 mmHg in the IPAA group (P < 0.01). The anorectal inhibitory reflex was positive in 18 patients (90%) from the IACA group and 5 (42%) from the IPAA group (P < 0.05). The pre- and postoperative MRPs were 61 mmHg and 55 mmHg, respectively, in the IACA group vs 63 mmHg and 34 mmHg, respectively, in the IPAA group (P < 0.01). Whereas 16 (80%) of the 20 IACA patients could discriminate feces from gas, only 4 (33%) of the 12 IPAA patients could (P < 0.05). The mean observation period was 2.3 years, the mean length of the columnar cuff was 2.8 cm, and no case of dysplasia or adenoma was seen. Postoperative function is more favorable following IACA than following IPAA, both physiologically and symptomatically. However, long-term surveillance of the residual mucosa is necessary before making a final recommendation. Received: April 20, 1999 / Accepted: January 7, 2000     

全大肠切除回肠贮袋肛管吻合术的远期疗效评价

目的　探讨全大肠切除回肠贮袋肛管吻合术治疗溃疡性结肠炎 (UC)和家族性腺瘤性息肉病 (FAP)的远期疗效。方法　 1985～ 2 0 0 2年间共对 6 1例患者行全结肠直肠切除回肠贮袋肛管吻合术 ,其中UC 2 5例、FAP 34例、其他 2例 ,应用S袋 2 5例、S J袋 13例、J袋 17例以及W袋 6例 ,术后随诊 1～ 18年、平均 8年 ,比较分析术后控便功能及并发症。结果　全部患者存活。并发症发生率为 16 % ( 10 / 6 1) ,其中UC患者 ( 2 4 % ,6 / 2 5 )高于FAP患者 ( 12 % ,4 / 34) ,W袋高于其他各袋 ,手法吻合 ( 2 0 % ,8/ 4 1)高于吻合器吻合 ( 10 % ,2 / 2 0 ) ,但差异均无显著性 (P >0 0 5 )。术后 2 4h大便次数平均为 4 2次。日间 84 % ( 4 3/ 5 1)、夜间 75 % ( 38/ 5 1)的患者排便能自控 ,6 % ( 3/ 5 1)的患者有明显的大便失禁。大部分患者对目前的生活质量表示满意。结论　全大肠切除回肠贮袋肛管吻合术治疗可维持UC与FAP患者肛管自控功能和可接受的大便次数 ,术后并发症较少 ,是较为理想的手术方式     

Prä- und postoperative Lebensqualität von Patienten mit Colitis ulcerosa und familiärer adenomatöser Polyposis bei ileoanaler Pouchoperation

After ileal pouch-anal anastomosis in patients with ulcerative colitis (UC) and familial adenomatous polyposis (FAP), in addition to postoperative morbidity and functional outcome quality of life is a relevant factor for assessment of the operation's success. Between 1982 and 1997 restorative proctocolectomy was performed in 602 patients (UC: n = 424; FAP: n = 178) at the Department of Surgery, University of Heidelberg. The assessment of pre- and postoperative quality of life was done through a prospective study (before restorative proctocolectomy, before and 1 year after closure of ileostomy). This study (UC: n = 27; FAP: n = 7) revealed a poor preoperative quality of life in patients with ulcerative colitis. Proctocolectomy is the decisive factor for the improvement of quality of life in the surgical treatment in UC. Quality of life could not be further significantly improved by ileostomy closure. Before proctocolectomy, FAP patients showed a quality of life, activity and function similar to that of healthy controls. In FAP patients proctocolectomy led to a significant loss of quality of life. This loss could only partly be regained by ileostomy closure. Quality of life and activity comparable to that of healthy controls can be achieved in UC patients by restorative proctocolectomy.     

Successful local excision of ileostomy adenocarcinoma after colectomy for familial adenomatous polyposis: report of a case

Primary adenocarcinoma rarely develops at the site of an ileostomy performed for ulcerative colitis (UC), familial adenomatous polyposis (FAP), or Crohn's disease. We describe a case of ileostomy cancer found 14 years after proctocolectomy for FAP with cancer of both the sigmoid colon and rectum. Resection of the ileal mucosa around the stoma was performed three times. To our knowledge, only 35 other such cases have ever been reported. Our review of these cases indicates that routine examination of the stoma by a physician, or even by the patient, may lead to earlier detection of this rare complication, and a better chance of cure through minimal surgery. Received: February 19, 2001 / Accepted: November 20, 2001     

Restorative proctocolectomy with and without protective ileostomy in a pediatric population

Purpose

This study aim was to review outcomes of pediatric patients after restorative proctocolectomy with or without a protective ileostomy in the treatment of ulcerative colitis and polyposis syndromes.

Methods

All patients who underwent rectal mucosectomy with ileal pouch reservoir and hand-sewn ileal pouch anal anastomosis (IPAA) during 19-year period were reviewed retrospectively.

Results

Eighty-three patients with ulcerative colitis and 7 patients with polyposis syndromes (ages 2.0-21.8 years) were reviewed. Sixty-eight patients underwent IPAA without diverting ileostomy. Fifty-six patients underwent restorative proctocolectomy as single-stage procedures, and 12 had abdominal colectomy and subsequent definitive IPAA without diverting ileostomy. Nineteen patients had IPAA with diverting ileostomy and subsequent closure of ileostomy. Three-stage procedures were performed in 3 cases. An ileal pouch leak or pelvic abscess occurred in 2 patients. Surgical pouch revision for retraction, efferent limb syndrome, prolapse, pouchitis, or perirectal infections occurred in 19 (6/62 J-pouch, 13/28 S-pouch). Fourteen patients (5/22 with diversion, 9/68 without diversion) developed small bowel obstruction. Overall, daytime and nighttime continence was excellent with rare nocturnal evacuations.

Conclusions

Restorative proctocolectomy without protective ileostomy is not associated with an increased morbidity, even in patients with active colitis, and may be appropriate most patients.     

家族性腺瘤性息肉病两种术式的对比研究

目的探讨家族性腺瘤性息肉病采用回肠贮袋肛管吻合术与回肠直肠吻合术两种术式的手术效果。方法回顾性分析两组在手术结果、术后排便功能和生活质量的差异。结果30例患者中行回肠直肠吻合术12例,贮袋吻合术18例,术后无死亡,无吻合口瘘等严重并发症,均无膀胱和性功能障碍。平均住院时间、手术时间和失血量直接吻合组优于贮袋组(P<0 01),在并发症发生率、术后排气排便时间和肠蠕动次数两组相似(P>0 05)。随访时间最短6个月,最长16年。3例(25% )直接吻合者术后直肠息肉癌变需切除直肠。两种术式的术后排便功能相似,仅在白天排便次数和肛周刺激方面IRA组优于IPAA组(P<0 05)。结论两组患者术后排便功能和术后生活质量相似,但回肠贮袋肛管吻合术可减少术后残留的直肠黏膜癌变机会,因而是较理想的手术方式。