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。

Surgical treatment of familial adenomatous polyposis with stapled technique

Objective To evaluate the surgical management of familial adenomatous polyposis with stapled technique. Methods Twenty-one patients with familial adenomatous polyposis underwent surgical treatment with stapled technique in Tongji Hospital,Tongji Medical College of Huazhong University of Science and Technology from January 2000 to December 2005 were reviewed retrospectively. Results Twenty-one patients with familial adenomatous polyposis were performed restorative proctocolectomy,ileal J-pouch anal anastomosis and protective ileostomy with stapled technique. There was no mortality, no severe complications such as anal anastomotic fistula, pelvic infection, and anastomotic stenosis and so on. In the follow-up, 1 case with ileal pouch adherence was treated endoscopically; polyps in ileal pouch were found in 2 patients and excised endoscopically. All patients had ideal continence function ,the defecation frequency per 24 hours were 2 to 5 times. Conclusion Restorative proctocolectomy,ileal J-pouch anal anastomosis and protective ileostomy with stapled technique may be considered the preferred surgical treatment for patients with familial adenomatous polyposis. It is a safe,simple,save time and little complication procedure. After operation, all patients should be followed up in order to found and treat recurrent polyps.