中国人231例家族性腺瘤性息肉病术式选择的Meta分析

Meta analysis of surgical treatment of 231 cases of familial adenomatous polyposis in China

目的：荟萃分析中国人家族性腺瘤性息肉病（FAP）的临床特征及手术术式。方法：以“家族性腺瘤性息肉病”为检索词，电脑检索2000～2006年国内公开发表的中文文献，统一纳入和排除标准，对所得资料进行荟萃分析。结果：男137例（59．3％），女94例（40．7％），男：女=1．46：1。有明确家族性腺瘤性息肉病家族史者占51．2％，平均发病年龄27．8岁，腺瘤癌变率为47．5％，腺瘤癌变者平均年龄35．9岁。术式选择全结肠直肠切除＋末端回肠腹壁造口术（TPA）60例（26．0％），全结肠部分直肠切除＋回肠直肠吻合术（IRA）63例（27．3％），全结肠直肠切除＋回肠肛管吻合术（IAA）12例（5．2％），全结肠直肠切除＋回肠储袋肛管吻合术（IPAA）19例（8．2％），全结肠部分直肠切除＋残留直肠黏膜剥脱＋经直肠肌鞘回肠肛管吻合术22例（9．5％），全结肠部分直肠切除＋残留直肠黏膜剥脱＋经直肠肌鞘回肠储袋肛管吻合术47例（20．3％），部分结肠或直肠切除术8例（3．5％）。结论：FAP是临床常见的多发生于结直肠的遗传性疾病，但文献报道不多，病例数较少；腺瘤发病早，癌变比率高；症状主要为大便习惯改变；诊断主要靠下消化道造影及纤维结肠镜检查；术式选择时应根据患者具体情况采用个体化手术方式；良性者预后较好，已癌变者预后也较原发结直肠癌为好。

OBJECTIVE： To meta analyze the clinical trait and surgical treatment of familial adenomatous polyposis （FAP） in China. METHODS： With ＂familial adenomatous polyposis＂ as search words, and with the same inclusion and exclusion criteria, related Chinese literatures published were retrieved. A meta analysis was carried out. RESULTS： The group included 137 male patients （59.3%） and 94 female patients （40.7%）, male , female= 1.46 ： 1. A family history was found in 47.5 patients. The average age was 27.8 years, and there were 47.5 %patients with malignant change, the average age of them was 35.9 years. The choice of operative procedures included total proctocolectomy with ileostomy in 60 cases （26.0%）, subtotal colectomy ＋ rectal polyposis electrocautery in 63 cases （27.3 % ）, total colectomy or proctocolectomy with ileo-anal anastomosis in 12 cases （5.2 % ）, total colectomy or proctocolectomy with ileal pouch-anal anastomosis in 19 cases （8.2%）, subtotal colectomy ＋ rectal mucosectomy, through the muscular sheath of rectum ileo-anal anastomosis in 22 cases （9.5 %）, ileal pouch-anal anastomosis in 47 cases （20. 3 %）, and subtotal proctocolectomy in 8 cases （3.5 %）. CONCLUSIONS： FAP is one of the common heredofamilial diseases, but rare in literatures. The occurrence of polyposis is very early and it is with high rate of malignant change. The most common symptom is a change of stool habit. The diagnosis mainly depends on colonoscopy and lower G. I tract radiography. The surgical treatment should be choosed according to the situation of every patient. The prognosis of FAP is good in spite of malignant change or not.