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。

A comparative study on two surgical modalities for the treatment of familial adenomatous polyposis

Objective To evaluate long term outcome of ileal pouch anal anastomosis(IPAA )and ileorectal anastomosis(IRA) in patients with familial adenomatous polyposis(FAP). Methods From 1976 to 2001, 30 patients with FAP were retrospectively reviewed. Results IPAA was performed on 18 patients and IRA on 12. The length of J pouch was 10~15 cm.There was no postoperative death, no anal anastomotic fistula and no urinary or sexual dysfunction occurred. Pouchitis was not serious. The functional results in IPAA group such as defecation frequency, daytime and nighttime continence, urgency, antidiarrhea drug use, were similar to that of IRA group( P >0 05), with better results of daytime defecation frequency and anal skin irritation in IRA group( P <0 05). The quality of life was satisfactory in both groups. During the follow up rectal carcinoma developed in 3 cases in IRA group. Conclusions IPAA was an ideal procedure to treat FAP, which is avoidable of remaining rectal cancerization, with satisfactory defecation function and quality of life.