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

Total proctocolectomy ileal pouch anal anastomosis for the treatment of familial adenomatous polyposis in45 cases

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5cmH2O，频率为13次／min，肛管收缩压平均180cmH2O。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。

Objective To evaluate total proctocolectomy ileal pouch anal anastomosis （IPAA） for the treatment of familial adenomatous polyposis （FAP）. Methods The operative modality, complications, follow-up data including colonoscopic findings and anorectal manometry in 45 patients with FAP （ 1995-2005） were retrospectively analyzed. Results One patient suffered from anastomotic leak. Patients＇ average postoperative defecation frequency was 9 times per day during the first 3 months; 5 times per day 6 months after; 4 times per day in 12 months. Average postoperative anal resting pressure was 5 cm H2O with a frequency of 13 times per min. The average squeeze pressure was 180 cm H2O. Regular colonoscopic follow-up made in 37 cases found polyps recurrence in the pouch in 14 cases （37.8%）. Intestinal mesentery desmoid tumors developed in 4 cases. Conclusion The total proctocolectomy ileal J-Pouch anal anastomosis is an effective therapy for FAP. Patients with ileal J-Pouch have good continence function after proctocolectomy. Patients must be followed up closely for the occurrence of extracolonic tumors.