离断肠系膜上动、静脉，全直肠肌鞘内回肠袋-肛管吻合术治疗家族性结肠息肉病

Total proctocolectomy with SMA ＆ V severance and ileal pouch- anal anastomosis for familial polyposis coli

目的探讨全结肠及低位直肠黏膜切除，离断肠系膜上动、静脉，全直肠肌鞘内回肠贮袋-肛管吻合术治疗家族性结肠息肉病的临床价值。方法对6例家族性结肠息肉病患者采用离断肠系膜上动、静脉以松解小肠系膜，全直肠肌鞘内回肠袋-肛管吻合术，并随访4个月至17年，评价术后近期及远期效果。结果术后3～7d，患者即可区分肠内气体与粪便；术后7～10d，大便转为成形。5例随访3～17年，大便17欠／d，无夜便粪污，小便正常；1例随访4个月，大便2次／d，无夜便。6例患者大、小便均正常，植物神经功能和性功能正常，6例均无感染和息肉复发。结论离断肠系膜上动、静脉后肠系膜可获充分松解，再行全直肠肌鞘内回肠袋-肛管吻合术对家族性结肠息肉病治疗效果是满意的。

Objective To investigate the clinical value of a newly designed surgical therapy for familial polyposis coli by severing the superior mesenteric artery ＆ vein in order to make a complete lysis of the mesentery and an ileum pouch and the anal anastomosis within the entire muscular sheath of the rectum. Methods Six patients with familial polyposis coli （ 5 males and 1 female, aged 24 - 36 years） were admitted and underwent the procedure which was consisted of： （ 1 ） An incision was made in the left middle and lower parts of the rectus abdominis; （2） The greater omentum was retained and the large intestine was removed ; （3） At the juncture of the sigmoid colon and the rectum, the muscular sheath was dissociated 0. 5 cm, the mucous membrane of the rectum was stripped in a revolving manner, the nourishing artery and vein in the membrane were exposed, and clamped and cut in sequence up to the anocutaneoue line; （4） The rectal mucous membrane was completely removed; （5） Under the right colonic artery, the superior mesenteric artery and vein were severed; （6） An N-, J- or W-shaped pouch was made in the ileum accordingly ; （7） An anastomosis of the ileum pouch and the anal canal was made within the entire muscular sheath of the rectum, and a drainage was placed; （ 8 ） The mesostenium was fixed on the right posterior abdomen, the small intestines were spread out to the right side, and the mesostenium was covered on the coarse surface of the colon bed ; （9） A tube was placed in the left lower abdomen for a vacuum aspiration for 2 days after operation, combined with the suction drainage, to eliminate the pelvic effusions; and （10） The abdomen was closed. Results Patients were able to discriminate stools and flatus 3 -7 days after operation, and the formed stools occurred 7 - 10 days after operation. Five patients were followed-up for 3 - 17 years, with averagely one defecation a day, with no night defecation and seepage. Urination was normal; In another one patient who underwent the procedure 4 months ago the defecation was twice a day, with no night defecation. All the 6 patients had normal autonomic nerve function and sexual function as well as normal defecation and urination, with no recurrence of polyposis coli or infection. The small bowel functions well with no ischemia related symptoms. Conclusion Cutting the superior mesenteric artery and vein and then making anastomosis of the ileum pouch and the anal canal within the muscular sheath of the rectum is a new surgical approach to familial polyposis coli. It is safe and significantly improves the patients＇ life quality.