全大肠切除直肠肌鞘内回肠造袋肛门吻合术治疗家族性腺瘤性息肉病

Total colectomy lieal pouch-anal anastomosis for familial adenomatous polyposis

家族性腺癌性息肉病（ＦＡＰ）为一种常染色体显性遗传病，如不手术治疗终将发生癌变。现已公认本病的最佳术式为全大肠切除，直肠粘膜剥除，回肠造袋肛门吻合术。作者近９年内施行此手术１１例。患者年龄为１９～６５岁。５例在３０岁以内。平均随访１～９年，效果满意。除２例切口感染外无其它并发症。每日大便４～６次，能恢复工作。手术时５例已有恶变，其中１例有单个肝转移灶同时行局部切除。手术要点为：肌鞘宜短，充分止血并放置引流，无张力吻合，保护性回肠造口。作者认为除直肠内仅少数息肉，患者能坚持随访者外，均宜采用本术式。

It has been established that the best surgical treatment of familial adenomatous polyposis(FAP)is total colectomy,rectal mucosa removal and ileo-anal anastomosis with pouch formation.Eleven cases,age ranging from 19 to 65 including five young patients of less than 30 years old,were treated. Bowel movements were 4-6 per day and patients could resume their work.Five patients were found with malignant change during the operation,and one had a solitary deposit in the liver which was locally resected.The lieal pouches were constructed as J type in ten and S type in one.There was no major morbidity except mild wound infection in 2 cases.Short segment of rectal muscular sheath, tension free pull-through anastomosis,protective ileostomy,which was closed three months later,and effective drainage of the rectal sheath were imperative for the success of the procedure.