三环形回肠贮袋-肛管吻合术在全结肠切除术中的应用

Application of Three-ring Ileum Pouch in Ileoanal Anastomosis for Pancolectomy

目的探讨全结肠切除后三环形回肠贮袋-肛管吻合加选择性截流术的价值。方法1994年9月至2004年9月对18例全结肠切除患者应用三环形回肠贮袋加选择性截流术,其中家族性大肠腺瘤性息肉病14例,溃疡性结肠炎4例。结果18例获12月～5年随访,无手术死亡。术后发生并发症3例(16.7%),贮袋阴道瘘、早期炎性肠梗阻、切口感染各1例,均治愈。术后平均排便频率:术后2周内4.9次/d,1个月3.8次/d,6个月3.1次/d,1年1.8次/d。至6个月时都能控制干便,其中控制正常者15例(83.3%),控制欠佳者3例(16.7%),无大便失禁。但稀便控制能力较差,至1年时仍有1例(5.6%)患者稀便失禁。无一例须插管排空。结论全结肠切除后三环形回肠贮袋肛管吻合加选择性截流术操作简单,手术并发症少,术后排便功能好,是家族性大肠腺瘤性息肉病和严重溃疡性结肠炎全结肠切除后较为合适的消化道重建方式。

Objective To assess the three-ring ileum pouch in ileoanal anastomosis and selective blocking for pancolectomy. Methods 18 cases of pancolectomy underwent the ileoanal anastomosis with threering ileum pouch and selective blocking from September 1994 to September 2004, including 14 cases of familial adenomatous polyposis（FAP） and 4 cases of ulcerative colitis（UC）. Result No perioperative death, 3 cases experienced complications including pouch-vaginal fistula, inflammatory bowel obstruction and incision infection each once, which were all conservatively cured thereafter. Postoperative defecation times were averagely 4.9, 3.8, 3.1 and 1.8 per day at 2 weeks, 1 month, 6 month and 1 year postoperatively, respectively. In terms of solid feces continence at 6 months postoperatively, 15 cases did very well whereas 3 cases didnt but not as bad as incontinence. In terms of liquid feces continence, there was 1 case still out of control at 1 year postoperatively while the others, although did better than incontinence, experienced varied degree of problem in controlling the liquid feces. None needed lavement. Conclusion This technique is favorable with regard to the postoperative defecation function with low complication rate, and is recommendable for the alimentary tract reconstruction after pancolectomy for FAP and UC.